DATE  DUE 

yt/%  icc- 

'jp,  1 6 \S9< 

— * ••  . 


Digitized  by  the  Internet  Archive 
in  2016  with  funding  from 
Duke  University  Libraries 


https://archive.org/details/historyofpediatr01garr 


CONTRIBUTORS  TO  THE  WORK 


Isaac  A.  Abt,  M.D. 

Samuel  Amberg,  M.D. 

John  F.  Anderson,  M.D. 
Murray  H.  Bass,  M.D. 
Kenneth  D.  Blackfan,  M.D. 
Richard  A.  Bolt,  M.D. 
Joseph  Brennemann,  M.D. 
Albert  H.  Byfield,  M.D. 

Carl  D.  Camp,  M.D. 

Henry  K.  Carter,  M.D. 
Wyman  C.  Cole,  M.D. 
Arthur  N.  Collins,  M.D. 

Jean  V.  Cooke,  M.D. 

Robert  A.  Cooke,  M.D. 
Thomas  B.  Cooley,  M.D. 
William  J.  Corcoran,  M.D. 
Robert  D.  Curtis,  M.D. 
Walter  E.  Dandy,  M.D. 

Carl  B.  Davis,  M.D. 

Wilburt  Cornell  Davison, 
M.D. 

L.  W.  Dean,  M.D. 

L.  R.  DeBuys,  M.D. 

B.  G.  de  Vries,  D.D.S. 

Henry  Dietrich,  M.D. 

John  M.  Dodson,  M.D. 
Frederick  G.  Dyas,  M.D. 
Daniel  N.  Eisendrath,  M.D. 
Charles  P.  Emerson,  M.D. 

A.  W.  Fairbanks,  M.D. 
Palmer  Findley,  M.D. 

Clark  W.  Finnerud,  M.D. 

E.  C.  Fleischner,  M.D. 

Otto  H.  Foerster,  M.D. 

John  Foote,  M.D. 

Albert  H.  Freiberg,  M.D. 
Stanton  A.  Friedberg,  M.D. 
Alfred  Friedlander,  M.D. 
Fielding  H.  Garrison,  M.D. 
Jesse  R.  Gerstley,  M.D. 
Bernard  Glueck,  M.D. 

Emil  Goetsch,  M.D. 

A.  F.  Goodman,  M.D. 

Evarts  A.  Graham,  M.D. 
Clifford  G.  Grulee,  M.D. 
Ralph  Hamill,  M.D. 

Thor  Wagner  I Iarmer,  M.D. 
George  B.  Hassin,  M.D. 
Harold  M.  Hays,  M.D. 
Henry  Heirnan,  M.D. 


Paul  G.  Heineman,  Ph.D. 
Victor  G.  Heiser,  M.D. 
Henry  F.  Helmholz,  M.D. 
Theodore  C.  Hempelmann, 
M.D. 

Isabella  C.  Herb,  M.D. 
Charles  Herrman,  M.D. 
Alfred  F.  Hess,  M.D. 

Julius  H.  Hess,  M.D. 

B.  Raymond  Hoobler,  M.D. 
R.  G.  Hoskins,  M.D. 

John  Howland,  M.D. 

C.  M.  Jacobs,  M.D. 

Mark  Jampolis,  M.D. 

Nelson  W.  Janney,  M.D. 
Philip  C.  Jeans,  M.D. 

Smith  Ely  Jelliffe,  M.D. 

Max  Kahn,  M.D. 

Arthur  Isaac  Kendall,  Ph. 

D.,  Dr.  P.H. 

Elmer  L.  Kenyon,  M.D. 

J.  H.  Mason  Knox,  Jr.,  M.D. 
William  Krauss,  M.D. 
Maynard  Ladd,  M.D. 

Jerome  S.  Leopold,  M.D. 
Abraham  Levinson  M.D. 
Dean  Lewis,  M.D. 

Clarence  C.  Little,  S.D. 
William  Palmer  Lucas,  M.D. 
W.  McKim  Marriott,  VI. D. 
Leo  Mayer,  M.D. 

John  F.  McClendon,  Ph.D. 
Ernest  L.  McEwen,  VI. D. 

F.  IT  McMechan,  M.D. 

May  Michael,  VI. D. 

Edward  C.  Mitchell,  VI. D. 
James  IT  Mitchell,  M.D. 
Edward  A.  Morgan,  VI. B. 
John  R.  Murlin,  Ph.D.,D.  Sc. 
Josephine  B.  Neal,  M.D. 
Frank  C.  Neff,  M.D. 

Wade  Wright  Oliver,  VI. D. 
Archer  O’Reilley,  M.D. 
Oliver  S.  Ormsby,  VI. D. 
Hiram  Winnett  Orr,  VI. D. 
William  H.  Park,  M.D. 

N.  O.  Pearce,  M.D. 

D.  B.  Phemister,  M.D. 
Clemens  Pirquet,  M.D. 

Lewis  J.  Pollock,  M.D. 


Langley  Porter,  VI. D. 

Walter  R.  Ramsey,  VI. D. 
Harry  VI.  Richter,  VI. D. 
John  Ridlon,  M.D. 

T.  Brailsford  Robertson, 
Ph.D.,  D.Sc. 

Frederick  C.  Rodda,  VI. D. 
Lawrence  T.  Royster,  VI. D. 
John  Ruhrah,  VI. D. 

Edwin  W.  Ryerson,  M.D. 
Ernest  Sachs,  VI. D. 

Louis  W.  Sauer,  VI.D. 
Richard  E.  Scammon,  Ph.D. 
William  Scheppegrell,  VI.D. 
Frederick  W.  Schlutz,  VI.D. 
Louis  E.  Schmidt,  VI.D. 
Richard  E.  Schmidt,  Archi- 
tect 

Oscar  T.  Schultz,  VI.D. 
Herman  Schwarz,  VI.D. 
Julius  P.  Sedgwick,  VI.D. 
Max  Seham,  VI.D. 

George  E.  Shambaugh,  VI.D. 
Henry  L.  K.  Shaw,  VI.D. 

De  Witt  H.  Sherman,  VI.D. 
James  P.  Simonds,  VI.D. 

J.  Ross  Snyder,  VI.D. 

Heman  Spalding,  VI.D. 
Arthur  Steindler,  VI.D. 

Percy  G.  Stiles,  Ph.D. 

Arthur  W.  Stillians,  VI.D. 
James  S.  Stone,  M.D. 
Solomon  Strouse,  VI.D. 

Fritz  B.  Talbot,  M.D. 

J.  E.  VI.  Thomson,  VI.D. 
Lester  J.  Unger,  VI.D. 
Edward  B.  Vedder,  VI.D. 
Borden  S.  Veeder,  VI.D. 
Frederick  L.  Wakeham,VI.D. 
Henry  B.  Ward,  Ph.D., 
D.Sc. 

George  H.  Weaver,  VI.D. 
William  Weston,  VI.D. 

Carl  J.  Wiggers,  VI.D. 

Anna  W.  Williams,  VI.D. 
Casey  A.  Wood,  VI.D. 

Paul  G.  Woolley,  VI.D. 
Josephine  E.  Young,  VI.D. 
Erwin  P.  Zeisler,  VI.D. 
Abraham  Zingher,  VI.D. 


PEDIATRICS 

By  VARIOUS  AUTHORS 


Edited  by 

ISAAC  A.  ABT,  M.D. 

Professor  of  Diseases  of  Children,  Northwestern  University  Medical 
School,  Chicago;  Attending  Physician,  Sarah  Morris  Hospital 
for  Children  of  Michael  Reese  Hospital,  Chicago 


G o e^\  Sc  o 1 ^ n 

14s  s w,  r ^ c ^ 

VOLUME  I 
With  284  Illustrations 


JL  0 '«$  H 

PHILADELPHIA  AND  LONDON 

W.  B.  SAUNDERS  COMPANY 


ys  n 

Cf\Q  V\ 

1 ^^3 


Copyright,  1923,  by  W.  B.  Saunders  Company 


MADS  IN  17.  S.  A. 


PRESS  OF 


W.  B.  SAUNDERS  COMPANY 
PHILADELPHIA 


CONTRIBUTORS  TO  VOLUME  I 


ISAAC  ARTHUR  ABT,  M.D. 

Professor  of  Diseases  of  Children,  Northwestern  University  Medical  School,  Chicago; 
Attending  Physician,  Sarah  Morris  Children’s  Hospital,  Chicago;  Consulting 
Physician,  Provident  Hospital,  Chicago  Home  for  the 
Friendless,  and  Chicago  Orphan  Asylum 

FIELDING  H.  GARRISON,  A.B.,  M.D. 

Lieutenant-Colonel,  Medical  Corps,  U.  S.  Army,  Surgeon  General’s  Office, 

Washington,  D.  C. 

CLARENCE  COOK  LITTLE,  S.D. 

President,  University  of  Maine;  Research  Associate  of  the  Carnegie  Institution 

of  Washington 

jesse  f.  McClendon,  Ph.D. 

Professor  of  Physiological  Chemistry,  University  of  Minnesota 

JOHN  R.  MURLIN,  A.M.,  Ph.D.,  D.Sc. 

Professor  of  Physiology  and  Director  of  the  Department  of  Vital  Economics,  Univer- 
sity of  Rochester,  Rochester,  N.  Y. 

H.  WINNETT  ORR,  M.D.,  F.A.C.S. 

Chief  Surgeon,  Nebraska  Orthopedic  Hospital,  Lincoln,  Neb.,  Orthopedic  Surgeon 
St.  Elizabeth’s  Hospital,  Lincoln,  Neb. 

WALTER  R.  RAMSEY,  M.D. 

Associate  Professor  of  Pediatrics,  University  of  Minnesota 

THORBURN  BRAILSFORD  ROBERTSON,  Ph.D.,  D.Sc. 

Professor  of  Physiology  and  Biochemistry  and  Director  of  Research,  Animal  Products 
Research  Foundation,  University  of  Adelaide,  South  Australia; 

Honorary  Consulting  Biochemist  to  the  Adelaide  Hospital 

RICHARD  E.  SCAMMON,  Ph.D. 

Professor  of  Anatomy,  University  of  Minnesota 

FREDERICK  L.  WAKEHAM,  M.D. 

Former  Pediatrist,  Sydenham  Hospital  and  Mt.  Sinai  Hospital  Dispensary,  New 

York  City 

JOSEPHINE  E.  YOUNG,  M.D. 

Medical  Inspector,  Chicago  Public  Schools;  Medical  Adviser  of  Women,  University 
of  Chicago;  School  Physician,  School  of  Education,  University  of 
Chicago;  Assistant  Professor  of  Neurology,  Rush  Medical  College 


j 


PREFACE 


This  system  of  pediatrics  is  a collection  of  monographic  treatises 
on  subjects  of  interest  in  the  diseases  of  infancy  and  childhood.  While 
there  are  many  excellent  text-books  and  monographs  on  the  general 
and  special  subjects  of  children’s  diseases  in  the  English  language,  the 
information  here  collected  should  be  of  value  to  the  practitioner,  stud- 
ent and  teacher  alike. 

Preparations  were  made  for  the  publication  of  these  volumes  early 
in  1914.  Shortly  after  the  authors  had  been  selected  and  the  assign- 
ments distributed,  the  Great  War  distracted  the  attention  of  the  whole 
world  from  the  works  of  peace,  and  every  one’s  interest  became 
absorbed  in  wartime  measures.  Very  little  progress  with  the  publica- 
tion was  made  during  those  fateful  days  and  when,  in  1917,  America 
entered  the  war,  the  work  was  completely  interrupted.  Since  the 
close  of  the  war,  however,  the  contributors  have  rallied  to  the  support 
of  the  editor  and  publishers  and  have  given  unstintedly  of  their  time 
and  labor  to  bring  the  publication  to  successful  completion.  The 
earlier  contributions  have  been  revised  and  in  some  instances  wholly 
rewritten  to  bring  them  up  to  date. 

As  may  be  observed  from  the  short  historical  reference  to  encyclo- 
pedia publications  which  follows  this  introductory  note,  no  extensive 
compilation  of  pediatric  knowledge  has  been  published  since  the 
appearance  of  Keating’s  “Encyclopedia  on  Children”  which  appeared 
in  1889.  During  the  thirty-three  fruitful  years  which  have  elapsed 
since  the  publication  of  Keating’s  epoch-making  series  of  essays 
many  changes  and  advances  have  occurred  in  medical  knowledge;  it 
has  seemed  timely  and  fitting,  therefore,  that  a renewed  attempt  should 
be  made  to  collect  in  monographic  form  the  material  which  represents 
the  fundamental  knowledge  of  pediatrics.  This  I have  attempted  to 
do,  and  whatever  labor  it  has  cost,  I feel  I have  been  rewarded  in  the 
encouragement  and  cooperation  of  the  distinguished  workers  who 
have  assisted  in  making  these  volumes  possible.  Such  a collection  of 
essays  should  be  of  value  not  only  because  of  the  known  facts  which  are 
presented  but  also  because  it  will  serve  to  indicate  gaps  in  our  knowl- 
edge and  I have  felt  a satisfaction  in  the  thought  that  the  volumes 
would  stimulate  clinical  and  research  work,  especially  by  the  younger 
men  of  English-speaking  countries. 

In  addition  to  the  discussion  of  the  internal  diseases  of  children, 
subjects  of  surgical  interest  have  been  introduced,  because  after  all  a 
child  who  is  sick  may  require  medical  or  surgical  treatment  or  both, 
and  a well-trained  physician  not  only  desires  but  is  compelled  to  know 
when  surgical  treatment  is  indicated  and  the  manner  of  its  application. 


PREFACE 


The  medical  attendant  may  not  himself  be  a trained  surgical  techni- 
cian but  it  is  important  that  he  should  recognize  surgical  conditions 
and  seek  surgical  advice  when  it  is  required.  Surgery  of  childhood 
differs  somewhat  from  that  of  adults,  since  conditions  arise  in  infants 
and  young  children  which  do  not  occur  or  which  are  rare  in  later  life, 
and  there  are  points  of  difference  in  surgical  anatomy,  surgical  pathol- 
ogy, and  surgical  technic,  as  well  as  in  surgical  diagnosis,  which  are 
emphasized  by  the  contributors  to  these  books. 

During  the  years  which  have  passed  since  our  work  was  begun, 
Drs.  Mortimer  Frank,  Robert  Krost  and  J.  Louis  Schwartz  have  been 
called  by  death  before  the  completion  of  their  contributions.  Dr. 
Stanton  Friedberg  died  shortly  after  he  had  contributed  his  manu- 
script on  “Bronchoscopy  and  Esophagoscopy.” 

It  was  originally  intended  to  include  a number  of  chapters  on 
orthopedic  surgery  but  this  has  been  undertaken  under  separate 
editorial  management  and  it  is  proposed  to  publish  these  papers  in  a 
separate  volume. 

Finally  I would  express  a deep  sense  of  obligation  and  appreciation 
to  the  writers  who  have  contributed  these  monographs.  Those  of 
us  who  know  the  arduous  labors  of  the  average  medical  man  of  today 
know  best  how  much  self-sacrifice  and  toil  are  entailed  in  the  prepara- 
tion of  these  papers.  I desire  to  thank  Messrs.  W.  B.  Saunders  and 
Company,  the  publishers,  for  their  great  helpfulness  in  every  detail 
and  their  kindly  spirit.  I desire  to  make  special  mention  for  helpful 
suggestions  received  from  Drs.  Fielding  H.  Garrison,  John  Howland 
and  Morris  Fishbein.  I am  also  indebted  to  Dr.  William  J.  Corcoran 
who  has  rendered  valuable  aid  in  arranging  the  manuscript  and  in  the 
reading  of  proof;  and  to  Drs.  Johanna  Heumann,  I.  H.  Tumpeer  and 
Alice  Williams  who  have  assisted  in  various  ways. 


Chicago,  III. 


Isaac  A.  Abt. 


CONTENTS  OF  VOLUME  I 


Page 

Encyclopedias  Which  Refer  to  the  Diseases  of  Children. 

An  Introductory  Essay i 

By  Isaac  A.  Abt,  M.D. 

CHAPTER  I 

History  of  Pediatrics 1 

By  Fielding  H.  Garrison,  M.D. 

CHAPTER  II 

Congenital  and  Acquired  Predisposition  and  Heredity  . . 171 

By  Clarence  C.  Little,  S.D. 

CHAPTER  III 

A Summary  of  the  Anatomy  of  the  Infant  and  Child  . . . 257 

By  Richard  E.  Scammon,  Ph.  D. 

CHAPTER  IV 

Growth  and  Development 445 

By  T.  Brailsford  Robertson,  Ph.D.,  D.Sc. 

CHAPTER  V 

Physiology  of  Metabolism  in  Infancy  and  Childhood.  . . 520 

By  John  R.  Mhrlin,  Ph.D.,  D.Sc. 

CHAPTER  VI 

Application  of  Physical  Chemistry  to  the  Physiology  of 
Childhood 847 

By  J esse  F.  McClendon,  Ph.D. 

CHAPTER  VII 

Hygiene  of  the  Home 859 

By  Walter  Reeve  Ramsey,  M.D. 

CHAPTER  VIII 

Hygiene  of  the  School  Age 866 

By  Josephine  E.  Young,  M.D. 

CHAPTER  IX 

Hygiene  of  Infants  in  General 1132 

By  Walter  Reeve  Ramsey,  M.D. 


CONTENTS  OF  VOLUME  I 


CHAPTER  X 

Climatotherapy 1152 

By  Frederick  L.  Wakeham,  M.D. 

CHAPTER  XI 

Hygiene  of  Crippled  Children 1180 

By  H.  Winnett  Orr,  M.D. 

Index 1191 


f 


ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF 
CHILDREN.  AN  INTRODUCTORY  ESSAY 

By  Isaac  A.  Abt,  M.D., 

Chicago,  III. 

Although  the  name  encyclopedia  was  not  applied  until  the  16t.h 
century  it  is  recalled  that  composite  books  containing  all  the  knowledge 
of  the  period  were  published  as  early  as  that  of  Hwang-ti  (2698-2599 
B.C.)  This  Chinese  Emperor  and  philosopher  promulgated,  in  a 
system  of  internal  medicine,  a peculiar  doctrine  which  gave  personality 
to  the  intimate  relations  of  the  human  organs.  Of  the  Egyptian  papyri, 
that  of  Ebers,  about  1553  B.C.,  is  most  complete  in  its  recipes  and 
directions  for  the  treatment  of  various  diseases,  and  that  of  Smith, 
about  3000  B.C.,  recently  translated,  is  most  important  for  its  age 
and  for  its  rationality.  It  is  hardly  necessary  to  describe  completely 
these  works  of  which  so  much  has  been  written;  and  this  is  also  true 
of  the  medicine  of  the  Bible  and  the  Talmud.  These  extensive 
compilations  of  religious  thought  with  rules  for  hygienic  conduct  are 
especially  noteworthy  in  the  attention  paid  to  the  care  of  the  mother 
and  the  hygiene  of  the  newborn. 

ORIENTAL  MEDICINE 

Ethnologists  know  that  with  the  development  of  every  race  and 
nation  medicine  and  the  healing  art  assume  a conspicuous  place  in 
the  life  of  the  community.  It  is  not  surprising  to  find  that  even  among 
the  writings  of  the  ancient  Indians,  such  as  the  Veda  and  other  sacred 
books,  portions  by  the  two  physicians,  Charaka  and  Susruta,  1000 
B.C.,  had  an  important  place.  The  frequent  application  of  cold  water, 
a rational  hydrotherapy,  and  fantastic  charms,  incantations  and 
extraordinary  superstitions  associated,  for  example,  with  the  color  of 
drugs,  mark  the  medical  literature  of  this  epoch. 

GREEK  AND  ROMAN  MEDICINE 

The  Hippocratic  collection  of  writings,  as  pointed  out  by  Neuburger 
comprises  an  intersection  of  all  previous  tendencies  in  medicine,  united 
as  an  interwoven  thread,  stretching  backward  into  antiquity  and  for- 
ward to  the  present  day.  Whether  the  work  of  Hippocrates,  a single 
genius,  or  the  motley  heterogeneous  output  of  generations,  this  notable 
collection  must  be  considered  as  representing  the  inspiration  of  a 
master. 


11  ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF  CHILDREN 

Following  the  Hippocratic  writings  by  some  300  years  are  the  works 
of  Celsus  and  the  collections  of  Pliny,  the  former  basing  his  writings  on 
the  collection  of  Hippocrates  and  including  also  the  medicine  of  the 
Semitic  peoples,  the  latter  presenting  more  or  less  loosely  combined 
facts.  In  Pliny’s  writings  the  original  references  to  scurvy,  superfe- 
tation and  atavism  are  especially  noteworthy  for  the  disturbances  of 
infancy.  Equally  interesting,  moreover  are  the  satirical  shafts  of 
wit  aimed  at  the  physician  which  also  characterize  the  writings  of  other 
philosophers  of  the  period. 

Soranus  of  Ephesus,  100  A.D.,  was  a prolific  writer.  Of  his  numer- 
ous manuscripts  those  on  the  care  of  the  newborn,  the  nutrition  of  the 
infant,  the  selection  of  the  wet  nurse,  and  on  gynecology  and  obstetrics 
are  of  importance  as  references  to  the  early  literature  on  pediatrics. 
In  fact,  Sudhoff  has  said  of  him,  “ What  Celsus’  work  signified  for  medi- 
cine and  surgery,  this  work  of  Soranus  signified  for  gynecology, 
obstetrics  and  pediatrics  in  the  ancient  literature.” 

The  outstanding  treatises  of  the  medicine  of  the  middle  ages  are 
based  on  the  important  works  of  Galen  who  commenced  practice  in 
Rome  about  164  A.D.  His  compilations  were  extensive  and  his 
therapeutics  notable  for  their  dogmatism.  While  the  names  Celsus 
and  Galen  may  be  familiar,  Oribasius,  Paul  of  HCgina,  and  iEtius  of 
Amida  are  not  so  well  known,  although  each  is  credited  with  a great 
encyclopedia  of  the  medical  knowledge  of  his  day.  Oribasius  was  one 
of  the  last  of  the  Alexandrian  school.  His  larger  work  was  too  bulky  for 
general  use,  so  he  wrote  a summary  or  synopsis  which  was  said  to  have 
been  for  the  use  of  his  son.  This  sjmopsis  continued  for  a long  time 
to  be  the  source  for  medical  information  for  physicians  of  the  Byzantine 
and  Middle  Ages.  It  has  been  thought  that  by  writing  the  synopsis 
he  distracted  attention  from  the  ampler  work.  The  writings  of  Oriba- 
sius, Paul  of  fiEgina  and  HCtius  have  been  made  the  subject  of  an 
essay  on  plagiarism  by  Sir  Clifford  Allbutt,  and  yet  the  ability  to 
choose  with  judgment  is  in  itself  a fine  art. 

ARABIAN  MEDICINE 

In  the  Fit  zgerald  lectures  recently  delivered  by  Sir  William  Browne, 
an  erudite  and  beautiful  exposition  of  Arabian  medicine,  mention  is 
made  of  a work  of  medicine  and  natural  philosophy  written  about  850 
B.C.,  to  which  Ali-ibn-Ribban,  the  author,  gave  the  modest  title 
“Paradise  of  Wisdom.”  The  fame  of  the  Arabian  scientist  rests  not 
so  much  on  this  work,  however,  as  on  the  fact  that  he  was  one  of  the 
teachers  of  the  great  physician  Rhazes.  The  latter,  most  important 
among  Moslem  physicians,  wrote  an  extensive  treatise,  particularly 
noteworthy  for  its  citation  of  case  histories,  which  is  a classic  in  early 
Arabian  medicine.  In  Persia  100  years  later  appeared  the  prince  of 
physicians,  Avicenna.  He  has  been  well  called  the  Galen  of  the  Arabs 
for  he  was  a voluminous  writer  of  a systematic  type  of  mind.  The 
Canon  of  Avicenna  became  the  most  important  text  in  the  Moslem 


SCHOOL  OF  SALERNO 


111 


world  and  superseded  the  works  of  Rhazes  and  other  earlier  writers. 
From  the  twelfth  to  the  seventeenth  centuries  it  continued  to  be  the 
guide  of  medical  students  in  European  universities  and  Avicenna 
became  more  famous  than  Rhazes.  Up  to  about  1650  the  Canon  was 
still  used  as  a text-book  in  the  universities  of  Louvain  and  Montpellier. 

SCHOOL  OF  SALERNO 

During  the  Middle  Ages,  from  the  sixth  century  onward,  all  medical 
activities  were  gradually  circumscribed  by  the  church,  especially  by 
the  monks  who  were  well  educated  and  who  were  able  to  read  not  only 
their  own  but  also  foreign  languages.  The  two  chief  literary  works 
of  the  school  of  Salerno,  which  dominated  medicine  during  the  next 
half  century,  are  the  “Compendium  Salernitatum ” and  the  “Regimen 
Sanitas.”  The  “Compendium”  is  the  first  example  of  a complete 
text-book  of  medicine  and  surgery  in  which  many  experts  work  under 
the  direction  of  a single  editor.'  Many  subjects  were  considered 
including  venesection,  the  pulse,  the  urine  and  fever  all  of  which  were 
on  Hippocratic  principles.  The  “ Regimen  Sanitas”  was  a medical 
poem.  Verse-making  in  medicine  became  a genuine  medieval  fashion 
among  Christian  writers  of  this  period.  The  object  often  was  to  facili- 
tate committing  the  subject  to  memory.  The  “ Regimen  Sanitas” 
was  undoubtedly  a composite  work,  various  editions  being  made  from 
time  to  time. 

Up  to  the  16th  century,  therefore,  while  the  actual  knowledge  of 
medicine  as  a science  developed  but  little  there  were  gradually  being 
accumulated  a vast  amount  of  empirical  observations  and  data  and 
attempts  to  interpret  natural  phenomena  and  the  causes  and  nature 
of  human  diseases  in  terms  which  would  convey  such  knowledge  to 
future  generations.  Knowing  nothing  of  the  circulation  of  the  blood, 
the  physician  was  compelled  to  account  in  a vague  and  indefinite 
manner  for  the  phenomena  related  to  the  circulation.  The  limitation 
placed  on  the  acquiring  of  the  fundamental  knowledge  of  anatomy, 
physiology,  and  other  basic  sciences  permitted  only  limited  observa- 
tions and  stimulated  speculative  philosophy. 

Each  encyclopedist  of  this  early  period  borrowed  liberally  from 
his  predecessors  and  added  thereto  the  small  amount  of  observation 
and  a larger  amount  of  original  philosophy  which  represented  his  own 
contribution.  Even  the  men  of  genius  plundered  largely.  Among 
the  summists  and  copyists  of  Byzantium  such  natural  masters  as 
Soranus  and  Galen  plundered  largely,  literally  and  anonymously. 
The  Arabs  transcribed  the  Greeks,  the  Greeks  the  Latins,  and  the 
Latins  each  other.  Allbutt  suggests  that  Celsus  may  have  named  his 
sources  so  generously  because  he  was  a layman.  Pliny  helped  him- 
self lavishly  to  Dioscorides  but  makes  no  acknowledgments  to  him. 

With  the  natural  intermingling  of  nations  resulting  from  com- 
merce and  warfare  the  writings  of  physicians  of  one  nation  were 
liberally  transferred  into  the  literature  of  other  nations.  Medical 


IV  ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF  CHILDREN 

plagiarism  is  not  an  innovation  of  modern  times.  Perhaps  the  word 
“plagiarism”  is  harsh,  for  after  all  no  man  can  in  his  own  life  time 
accumulate  sufficient  experience  to  write  a complete  exposition  of 
even  a single  group  of  diseases.  It  is  the  mark  of  rationality  and 
progress  to  benefit  by  the  experiences  of  tfie  past. 

THE  SIXTEENTH  CENTURY 

Collective  writings  in' the  modern  sense  did  not  appear  until  about 
the  sixteenth  century,  when  a huge  “gynecia”  or  encyclopedia  of 
gynecology  was  issued  by  Caspar  Wolf  (1532-1601)  of  Zurich,  in  1566. 
This  was  later  enlarged  by  Caspar  Bauhin  (1550-1624)  of  Basel,  in 
1586.  These  two  compilations  of  the  best  that  has  been  written  on 
the  subject  were  afterward  reprinted  in  one  volume  by  Israel  Spach, 
of  Strassburg,  in  1597.  Encyclopedic  treatises  on  medicine  by  many 
authors,  not  unlike  the  works  written  on  the  cooperative  plan  in  our 
own  time,  were  a special  feature  of  the  medicine  of  the  Renaissance 
and  of  these  we  may  mention,  in  addition  to  the  Basel  encyclopedias 
of  gynecology,  the  Aldine  “Medici  Antiqui  Omnes”  (1547),  the 
“Medicee  Artis  Principes”  of  Stephanus  (1567),  the  Venetian  anthol- 
ogy of  mineral  waters,  “De  Balneis”  (1553),  the  Gesner  collection  of 
surgical  treatises  (Zurich,  1555)  and  the  medical  dictionaries  of 
Symphorien  Champier  (1506),  Lorenz  Phryesen  (1519),  Henri  Esti- 
enne  or  Stephanus  (1564)  and  Jean  de  Gorris  or  Gorrseus  (1564). 
With  these  may  be  classed  the  concordance  of  expressions  from 
Erotian  by  Eustachius  (1566),  the  “Varise  Lectiones”  (1571)  of 
Geronimo  Mercuriali  and  .the  “(Economia  Hippocratis,  ” a similar 
exegesis  by  Anutius  Fcesius  (1588). 

THE  SEVENTEENTH  CENTURY 

In  the  seventeenth  century  various  encyclopedic  works  were 
compiled.  In  1677  J.  J.  Hoffmann  published  in  Basel  his  “Lexicon 
Universale.”  This  was  more  in  the  nature  of  a dictionary,  in  the 
modern  sense,  though  it  gave  a summary  of  the  most  important 
facts  of  the  arts  and  sciences  as  they  were  understood  at  that  time. 

Among  other  works  of  this  period  were  the  “Biblioteca  Universale” 
of  Coronelli.  It  was  to  have  appeared  in  thirty-five  volumes,  though 
only  seven  were  published  (Venice,  1701-1706). 

A German  encyclopedia,  which  appeared  during  this  period,  was  a 
complete  collection  and  was  named  after  one  Zedler,  the  publisher 
who  produced  the  work.  It  was  entitled  “Grosses  vollstandiges 
Universal  Lexicon  aller  Wissenschaften  und  Kiinste.  ” 

Other  books  of  this  period  which  were  dictionary  compilations 
were  Hiibner’s  “ Konversationslexika ” (1704),  and  the  work  of 
Brockhaus  (1796-1808),  the  encyclopedias  of  Ephraim  Chambers 
(1728),  Diderot  (1751-1752),  Voltaire’s,  “ Dictionnaire  philosophique,” 
1784  and  the  “Encyclopedia  Britannica”  (1768-1771). 


THE  WORK  OF  TOBIAS 


V 


The  “Encyclopedia  Britannica, ” in  three  volumes,  was  completed 
by  a society  of  gentlemen  in  Scotland  in  1771. 

No  work  of  reference  has  been  more  useful  and  successful  or  more 
frequently  copied,  imitated  and  translated,  than  that  known  as  the 
“ Konversationslexikon  ” of  Brockhaus.  It  was  begun  in  1796-1801 
by  D.  Gotthelf  Renatus  Lobel. 

Diderot  published  his  “ Dictionnaire  universal  de  medicine”  in 
six  volumes  in  Paris,  1746-1748.  This  publication  was  a translation 
of  the  celebrated  “Medical  Dictionary”  of  Dr.  Robert  James,  inventor 
of  fever  powders  (London,  1743-1745).  It  consisted  of  three  volumes, 
3257  pages  and  98  plates,  comprising  a history  of  drugs,  chemistry, 
botany  and  natural  history  so  far  as  they  relate  to  medicine,  and 
contained  a historical  preface  of  99  pages. 

THE  WORK  OF  TOBIAS 

Levinson  recently  abstracted  the  work  of  Tobias  which  belongs  to 
the  latter  part  of  the  seventeenth  and  the  early  part  of  the  eighteenth 
centuries.  References  are  quoted  here  liberally  because  they  indicate 
the  nature  of  the  encyclopedic  writings  of  the  period.  Tobias  was  a 
wandering  practitioner  of  medicine  who  studied  in  different  countries. 
He  began  his  study  of  medicine  at  Krakow,  continued  his  course  at 
Frankfort,  obtained  his  degree  at  Padua,  practiced  in  Poland,  was 
attending  physician  to  five  sultans,  wrote  his  book  in  Adrianople, 
published  it  in  Venice,  held  a professorship  in  Constantinople,  and  died 
and  was  buried  in  Jerusalem.  His  ivanderlust  brought  him  into  contact 
with  the  greatest  authorities  of  his  age  and  enabled  him  to  study  the 
diseases  of  the  different  countries  in  their  nativity.  He  was  thoroughly 
conversant  in  nine  languages;  he  knew  their  daily  usage,  their  litera- 
ture, and  their  science. 

The  close  of  the  sixteenth  and  the  beginning  of  the  seventeenth 
centuries  were  crowded  with  events  in  the  field  of  science  in  general,  and 
of  medicine  in  particular.  Not  many  years  before  the  birth  of  Tobias 
Lord  Bacon  promulgated  the  inductive  method  of  philosophy  which 
exerted  a profound  effect  on  religious  and  philosophic  thought  through- 
out the  entire  world,  and  Copernicus  announced  the  view  of  the  solar 
system  that  moved  the  earth  from  its  place.  It  was  in  the  sixteenth 
century  that  Vesalius  dissected  human  bodies  and  thereby  put  anatomy 
on  a scientific  basis,  and  in  the  early  part  of  the  seventeenth  century 
Harvey  enriched  the  world  with  his  discovery  of  the  blood  circulation. 

During  these  years  Tobias  worked  indefatigably  on  a variety  of 
medical  problems.  The  results  of  his  labors  were  compiled  in  his  most 
representative  book,  “Maaseh  Tuviah.”  The  book  is  encyclopedic 
in  nature.  It  contains  thoughts  on  religion,  something  of  astronomy, 
geology,  chemistry,  and  indeed  a little  of  everything,  but  the  major 
part  of  its  contents  is  devoted  to  medicine.  Such  was  the  popular  way 
of  writing  in  his  day,  and  indeed,  books  such  as  his  served  a very  useful 
purpose.  They  furnished  a mirror  of  the  views  of  the  author  and  of 


Vi  ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF  CHILDREN 

his  contemporaries  not  only  on  the  main  subject  of  the  treatise,  but  on 
every  other  human  project  that  enlisted  the  interest  of  thinking  men. 
It  would  be  interesting  to  follow  Tobias  through  his  many  by-paths, 
were  we  not  especially  concerned  with  his  contributions  to  medical 
literature.  (Levinson,  “Medical  Cyclopedists  of  the  Seventeenth 
Century.”) 

Encyclopedias  in  the  modern  sense  originated  in  England.  France 
soon  followed  although  her  publications  were  written  in  a more  philo- 
sophic spirit.  In  Germany,  during  the  last  century,  publications  almost 
too  numerous  to  mention  have  been  issued  in  which  treatises  on  every 
possible  subject  were  collected  and  treated  in  detail.  These  works 
were  encyclopedic  in  that  they  were  compilations  of  various  subjects 
discussed  by  numerous  authors.  In  1834  publication  of  Schmitt’s 
“Jahrbucher”  was  commenced  and  they  have  continued  for  many 
years  to  furnish  abstracts  and  important  bibliography. 

SYSTEMS  OF  MEDICINE 

Among  the  most  important  of  the  general  medical  systems  is  that 
of  v.  Ziemssen.  The  first  volume  was  published  in  1876.  In  this 
collection  the  whole  field  of  internal  medicine  and  infectious  diseases 
was  covered  in  a masterful  way.  Many  of  the  monographs  emanated 
from  the  medical  leaders  of  the  time,  such  as  Liebermeister,  Cursch- 
mann,  Oertel,  Schrotter,  Naunyn,  v.  Ziemssen,  Steiner,  Steffen, 
Fraentzel,  Jiirgensen,  Rindfieiseh,  Quincke,  Zenker,  Kussmaul.  Erb, 
Senator,  Birch-Hirschfeld  and  a host  of  others.  This  system  was  the 
classical  reference  book  for  several  decades,  and  while  the  material 
advances  in  clinical  medicine,  pathology  and  phj-siological  chemistry 
have  rendered  these  volumes  obsolete,  nevertheless  the  clinical  obser- 
vations and  the  descriptions  of  disease  would  in  many  instances  be 
valuable  as  reference  for  the  modern  student  of  medicine.  The  authors 
who  contributed  to  this  series  were  masters  in  the  art  of  clinical 
medicine. 

The  Nothnagel  “System,”  which  is  a very  large  aggregation  of 
volumes,  covers  similar  material  to  that  of  v.  Ziemssen’s,  though  in  a 
more  modern  period.  The  monographs  are  in  most  instances  classical 
contributions  and  continue  to  be  of  value  to  the  present-day  student 
and  investigator. 

Another  system,  less  voluminous,  is  that  of  Ebstein  and  Schwalbe. 
More  recently  the  “Handbuch  der  innere  Medezin”  by  Mohr  and 
Staehlin  has  been  compiled,  and  still  more  recently  that  of  Friedrich 
Kraus  and  Theodor  Brugsch. 

The  unique  publication  by  Lubarsch  and  Ostertag  on  “ Ergebnisse 
der  allgemeinen  Pathologie  des  Menschenund  der  Thiere  ” is  a collection 
of  volumes  published  annually,  reviewing  in  a most  comprehensive 
manner  the  additions  to  pathologic  knowledge  and  constituting  a 
valuable  book  of  reference.  Penzoldt  and  Stintzing  compiled  a system 
of  therapeutics  in  1894. 


SYSTEMS  OF  PEDIATRICS 


Vll 


AMERICAN  AND  ENGLISH  SYSTEMS  OF  MEDICINE 

In  America  a system  of  practical  medicine  was  edited  in  1885  by 
William  Pepper,  assisted  by  Louis  Starr,  and  in  1907  Osier’s  “Modern 
Medicine,”  by  American  and  foreign  authors,  was  published.  The 
latter  contained  many  papers  of  striking  merit  and  has  served  as  an 
important  reference  work  for  students,  teachers  and  practitioners. 
In  addition,  numerous  encyclopedic  publications  on  surgery  and  other 
branches  of  medicine  have  been  published  in  America. 

Allbutt’s  “ System  of  Medicine,  ” an  English  publication  which 
appeared  in  1896,  contains  papers  by  English  and  American  authors. 
It  is  one  of  the  most  valuable  of  the  modern  English  encyclopedias. 
The  “ Twentieth  Century  Practice  of  Medicine  ” was  edited  by  Thomas 
L.  Stedman  of  New  York.  It  consists  of  20  volumes  and  contains 
many  interesting. and  valuable  contributions.  Among  other  encyclo- 
pedic books  published  during  the  last  two  decades  may  be  mentioned 
the  “Reference  Handbook  of  Medical  Sciences,”  the  first  edition  of 
which  appeared  in  1885-1893,  the  third  edition  in  1913;  systems  of 
therapeutics  edited  by  Hare  in  1891,  Solis-Cohen  in  1902,  Musser 
and  Kelly,  1911-1917,  and  Forchheimer  in  1906.  Barker’s  mono- 
graphs on  internal  medicine  appeared  in  1916,  and  the  “Encyklo- 
padische  Jahrbiicher  der  Gesamten  Heilkunde,  ” edited  by  A.  Eulenburg 
in  1907. 

SYSTEMS  OF  PEDIATRICS 

In  pediatrics  the  number  of  extensive  compilations  is  not  large. 
About  1773  in  Leipzig  a collection  of  interesting  treatises  was  published 
which  gave  in  detail  some  of  the  clinical  disorders  of  infancy  and 
childhood.  This  publication  consisted,  however,  of  a series  of  papers 
containing  clinical  descriptions.  In  1811  a series  of  essays  appeared 
in  France  entitled,  “La  Clinique  des  Hopitaux  des  Enfants  et  Revue 
Retrospective  Medico-Chirurgicale  et  Hygienique;  publices  sous  les 
auspices  et  par  les  medicine  et  chirurgiens  des  hopitaux  consacrees 
and  maladies  des  enfants.” 

Among  the  outstanding  systems  are  Gerhardt’s  “Handbuch  der 
Kinderkrankheiten,  ” 1877-1893;  John  M.  Keating’s  “Cyclopedia  of 
the  Diseases  of  Children,”  1889-1890;  J.  Grancher  and  J.  Comby’s 
“Traite  des  Maladies  des  Enfants,”  1897;  Pfaundler  and  Schloss- 
mann’s “Handbuch  der  Kinderheilkunde, ” 1906;  Anderodias  and 
Cruchet’s  “La  Pratique  des  Maladies  des  Enfants,  ” 1909.  Gerhardt’s 
Handbuch  was  an  epoch-making  publication  which  collected  the  most 
important  information  on  the  subject  and  for  many  years  stimulated 
study  and  research.  Henning’s  contribution  in  this  publication  was 
eagerly  read  by  the  specialist  and  consulted  by  those  who  desired 
information  on  the  history  and  development  of  the  pathology  of 
childhood.  Henke’s  dissertation  on  the  anatomy  of  childhood  has 
long  been  considered  a classic.  Vierordt  wrote  on  physiology,  con- 
tributing 288  pages  of  the  most  carefully  assembled  facts;  this  chapter 


Vlll  ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF  CHILDREN 


is  an  important  source  of  physiologic  knowledge  concerning  the  child. 
To  A.  Jacobi  was  assigned  the  hygiene  of  infants  and  children,  and 
the  subject  was  most  carefully  and  thoughtfully  treated.  C.  Binz 
wrote  on  therapeutics  and  Pfeiffer  on  infant  mortality.  In  the  same 
volume  Pfeiffer  wrote  on  vaccination  and  A.  Baginsky  on  school 
hygiene.  Rauchfuss  of  St.  Petersburg  considered  hospital  buildings, 
hospital  administration  and  equipment,  and  he  also  contributed  a 
chapter  on  congenital  heart  disease. 

It  is  not  necessary  to  give  in  detail  all  of  the  subjects  considered, 
but  perhaps  one  of  the  most  important  papers  was  that  of  Widerhofer 
and  Kundrat  on  the  gastro-intestinal  diseases  of  infancy.  Many 
new  theories  have  arisen  since  that  time.  New  information  in  chemis- 
try and  pathology  has  been  added  to  this  group  of  disorders,  and  the 
classification  proposed  by  Widerhofer  has  been  changed  time  and 
again,  but  the  keen  clinical  observations,  and  the  carefulW  expressed 
descriptions  have  remained  as  a basis  for  all  subsequent  discussion 
of  this  disease  group.  The  Gerhardt  “Handbuch,”  a pioneer  in 
modern  pediatric  writings,  has  been  a real  force  in  developing  the 
study  of  pathology  in  infants  and  children. 

Keating’s  “Encyclopedia”  was  published  in  1889  in  four  volumes 
and  ten  years  later  a supplement  appeared.  An  array  of  the  most 
distinguished  pediatric  teachers  and  thinkers  in  America  contributed 
to  this  work.  A.  Jacobi  wrote  the  introduction,  James  Finlayson,  of 
Glasgow,  made  a valuable  contribution  on  diagnosis,  Thomas  M. 
Rotch,  of  Boston,  wrote  the  chapter  on  infant  feeding,  W.  B.  Cheadle, 
of  London,  discussed  rheumatism  and  acute  and  chronic  endocarditis, 
Thomas  Barlow  described  rickets  and  scurvy,  William  Osier  contri- 
buted the  chapter  on  congenital  heart  affections,  L.  Emmett  Holt 
discussed  diarrheal  disorders,  acute  and  chronic,  and  J.  P.  Crozer 
Griffith  described  diseases  of  the  blood  and  the  blood-making  appa- 
ratus. The  other  distinguished  men  who  wrote  for  this  book  typify 
the  most  advanced  thought  on  their  special  subjects.  The  volumes 
had  an  important  and  stimulating  influence  on  English-speaking 
physicians,  and  served  to  call  attention  to  the  entire  field  of 
pediatrics  by  presenting  knowledge  in  a readily  accessible  form.  The 
work  awakened  a keen  interest  in  the  pathology  of  childhood  and 
Keating’s  treatise  was,  for  many  years,  the  standard  reference  book 
for  the  specialist  in  pediatrics  as  well  as  for  the  general  practitioner 
in  medicine. 

The  Pfaundler  and  Schlossmann  system,  published  in  German,  has 
been  translated  into  English.  The  first  volume  contains  a paper  by 
Franz  Hamburger,  of  Vienna,  on  general  pathogenesis  and  pathology 
of  childhood  and  deals  with  the  general  aspects  of  disease.  A very 
interesting  and  painstaking  chapter  is  that  of  Professor  M.  Pfaundler, 
now  of  Munich,  on  the  symptomatology  of  children’s  diseases.  He 
sets  forth  in  a very  elaborate  tabular  form  the  symptoms  which  may 
occur  in  the  various  diseases. 

The  contributions  of  G.  Bendix  on  general  prophylaxis,  H.  Neu- 


SPECIAL  WORKS  OF  PEDIATRIC  INTEREST 


IX 


mann  on  therapeutics  and  of  Prausnitz  on  mortality  and  morbidity 
are  worthy  of  careful  study.  Following  this  are  valuable  papers  by 
Raudnitz  on  milk,  two  papers  by  Camerer,  one  on  metabolism  and 
nutrition  during  the  first  year  of  life,  and  another  on  children’s  growth 
in  weight  and  height.  The  contributors  constitute  the  leading  authori- 
ties in  Germany  and  Austria  and,  while  these  volumes  were  published 
sixteen  years  ago,  they  still  constitute  an  authoritative  reference  work. 
Supplementary  volumes  have  been  published,  one  on  surgery  and 
orthopedics  and  another  on  nervous  diseases,  and  one  on  the  eye  and 
ear  and  speech  disturbances. 

SPECIAL  WORKS  OF  PEDIATRIC  INTEREST 

In  1905  “Die  Deutsche  Klinik”  included  a series  of  essays  on 
diseases  of  children  on  selected  topics.  Among  many  contributors  of 
distinction  Czerny  wrote  on  the  feeding  of  children,  Monti  on  the  most 
frequent  infections  of  the  buccal  mucous  membrane,  Soltmann  on 
scrofulosis  and  tuberculosis  of  children,  Escherich  on  acute  digestive 
disturbances  of  infants,  C.  Keller  on  disease  of  the  newborn,  and 
Heubner  on  measles. 

In  1913  appeared  the  first  volume  of  a book  entitled  “Handbuch 
der  allgemeinen  Pathologie  und  der  pathologischen  Anatomie  des 
Kindesalters,  ” edited  by  Briining  and  Schwalbe,  both  of  Rostock;  the 
book  considers  the  pathology  of  infants  and  children  and  also  dis- 
cusses at  considerable  length  the  various  malformations.  In  a special 
chapter  the  subject  of  comparative  pathology  is  treated  in  which  the 
diseases  of  young  animals  are  compared  with  those  of  young  children. 
The  infectious  and.  parasitic  invasion  of  young  animals,  as  well  as  the 
malformations  and  the  tumors,  are  discussed.  Nearly  every  tissue 
and  organ  is  studied  in  this  way  by  Jostand  Koch.  Publication  of  this 
work  was  interrupted  by  the  war  and  at  present  (1922)  it  is  not 
complete. 

A composite  volume  on  “Diseases  of  the  Nervous  System”  by 
Bruns,  Cramer  and  Ziehen,  which  appeared  in  1913,  contains  detailed 
descriptions  of  the  various  nervous  and  mental  diseases  incident  to 
infancy  and  childhood.  It  is  undoubtedly  one  of  the  best  reference 
books  of  its  kind. 

A very  valuable  book  on  the  hygiene  of  the  child  was  issued  by  W. 
Kruse  and  Paul  Selter  in  1914.  This  work  considers  growth  and 
development,  cause  of  disease,  infantile  nutrition,  protection  against 
heat  and  cold,  and  hygiene  of  the  environment.  Another  chapter  deals 
with  exercise  of  the  body  and  mind,  hygiene  of  infancy,  school  hygiene, 
hygiene  of  crippled  children,  training  of  defective  and  nervous  children 
and  a variety  of  other  subjects.  The  treatise  is  a valuable  collection 
of  monographs  for  those  who  are  especially  interested  in  the  hygiene 
and  diseases  of  infancy  and  childhood. 

The  “American  Text-book  of  Diseases  of  Children”  published  in 
1898  under  the  editorial  management  of  Louis  Starr  of  Philadelphia, 


X ENCYCLOPEDIAS  WHICH  REFER  TO  THE  DISEASES  OF  CHILDREN 

contains  valuable  contributions  by  American  authors  of  note.  H. 
Dwight  Chapin  wrote  the  chapter  on  hereditary  syphilis.  There  are 
excellent  chapters  on  infectious  and  digestive  diseases.  Victor 
Vaughan,  in  a notable  contribution  on  the  diarrheal  diseases,  was 
undoubtedly  one  of  the  earliest  writers  who  considered  that  the  gastro- 
intestinal diseases  of  infancy  may  be  caused  by  food  disturbances. 
The  late  Sir  William  Osier  wrote  the  chapter  on  tuberculosis  in  infancy, 
and  his  paper  was  one  of  the  best  on  the  subject  accessible  to  English 
readers  at  that  time.  The  chapters  on  nervous  diseases  in  children 
were  carefully  considered,  notably  the  papers  of  Frederick  Peterson, 
Charles  K.  Mills,  Allan  Starr  and  other  distinguished  authors. 

A composite  book  entitled  the  “Practice  of  Pediatrics,”  edited  by 
Walter  Lester  Carr,  was  published  in  1906.  It  contains  many  impor- 
tant contributions  and  in  addition  to  the  American  authors,  papers 
from  several  eminent  English  clinicians  are  presented. 

A unique  collection  of  books  entitled  “Collectanea  Jacobi”  in 
eight  volumes  was  edited  by  William  J.  Robinson.  These  volumes 
contain  the  various  publications  of  the  distinguished  pediatrician,  his 
medical  essays,  his  public  addresses  and  his  discussion  of  public 
problems.  These  papers  teem  with  medical  wisdom,  philosophic 
thought  and  an  unusual  human  understanding. 

An  English  book  on  “Diseases  of  Children”  by  various  authors, 
edited  by  Garrod,  Batten  and  Thursfield,  contains  a splendid  series 
of  contributions  with  excellent  clinical  descriptions  of  the  most  com- 
monly encountered  diseases  of  children. 

Feer’s  recent  work,  “Lehrbuch  der  Kinderheilkunde,”  published 
in  191 1 , is  a composite  book  and  up  to  the  present  time  has  gone  through 
seven  editions.  The  contributors  are  among  the  most  active  and  best 
known  German  pediatricians.  Finkelstein,  Ludwig  Meyer,  Pfaundler, 
von  Pirquet,  Noeggerath,  Ibrahim  and  Moro  contribute  the  various 
chapters. 

Kelynack  in  1908  published  a book  on  “Tuberculosis  in  Infancy  and 
Childhood”  by  numerous  English  and  some  American  authors.  It 
is  a brief  treatise  covering  about  350  pages.  The  same  author  has 
edited  a book  on  medical  examinations  of  schools  and  scholars  with  the 
collaboration  of  a number  of  British  writers,  though  there  are  some 
foreign  contributors  who  detail  school  examinations  as  carried  on  in 
their  own  countries.  The  edition  contains  contributions  from  Switzer- 
land, Sweden,  Norway,  Denmark,  France,  Germany  and  several  from 
leading  authorities  in  the  United  States. 

The  book  by  Grancher,  Comby  and  Marfan,  consisting  of  five 
volumes,  covers  the  general  field  of  pediatrics  and  includes  contributions 
by  a brilliant  array  of  French  and  foreign  scholars.  Ballantyne  of 
Edinburgh,  Barlow  of  London,  Bokay  of  Budapest,  Epstein  and 
Fischel  of  Prague,  and  Escherich  of  Vienna,  are  among  the  contributors. 

“La  Pratique  des  Maladies  des  Enfants,”  edited  by  Apert,  Cruehet 
and  Carriere,  is  a comprehensive  system  of  pediatrics  by  leading  French 
clinicians.  It  was  published  in  five  volumes  in  1912  by  J.  B.  Balliere. 


CONCLUSION 


XI 


CONCLUSION 

In  attempting  to  make  a rapid  survey  of  the  encyclopedic  literature 
vering  a vast  period  of  time  it  has  been  possible  to  mention  only  the 
outstanding  collections.  To  do  full  justice  to  any  of  them  would 
require  more  detailed  accounts  and  descriptions  of  greater  length.  It 
has  been  my  purpose  to  give  a brief  survey  of  the  rise,  existence  and 
development  of  this  kind  of  literature  as  well  as  to  consider  its  influence 
medical  thought  and  medical  progress. 

For  ages  medicine  was  in  a chaotic  state;  such  science  as  existed 
was  almost  hopelessly  mixed  with  empirical  deduction  and  inference, 
nchecked  by  rational  methods  of  control.  A glance  down  the 
nturies  from  the  time  of  Hippocrates,  the  first  real  physician  to  con- 
ive  the  idea  of  bringing  together  the  collected  wisdom  of  the  preced- 
ing ages,  reveals  many  encyclopedic  volumes  which  influenced  the 
ogress  of  contemporary  physicians  and  stimulated  succeeding 
g nerations  toward  greater  achievement. 

The  outstanding  lesson  to  be  learned  from  such  a historical  review 
is  the  fact  that  preeminent  thinkers  and  leaders — men  of  real  genius, 
do  not  appear  frequently.  Hippocrates  had  many  eminent  disciples, 
y t for  many  centuries  no  great  discovery  was  made  and  no  new  light 
was  shed  on  medical  problems.  Not  until  the  16th  century  did  the 
scientific  spirit  of  experiment,  observation  and  investigation  permit 
medicine  to  emerge  from  the  darkness.  The  development  of  physi- 
o1  )gy,  anatomy,  pathology  and  eventually  of  chemistry  lifted  the 
aling  art  out  of  the  abyss  of  ignorance,  philosophic  speculation  and 
certainty  and  placed  it  on  firm  ground  which  permitted  progressive 
a d rational  development. 

Great  geniuses — leaders  and  pathfinders — are  few  and  far  between, 
iiey  cannot  be  manufactured  by  pedagogic  methods,  either  ancient  or 
odern.  They  are  not  the  product  of  any  system  of  education;  they 
ai  e born  great  and  remain  so,  and  their  light  and  lustre  illuminate  the 
field  by  revealing  hidden  facts  and  by  uncovering  what  has  seemed 
■ ipenetrable.  It  falls  to  lesser  mortals  to  give  such  aid  and  encourage- 
n ent  as  they  can. 


A SYSTEM  OF  PEDIATRICS 


CHAPTER  I 

HISTORY  OF  PEDIATRICS 

By  Fielding  H.  Garrison,  M.D.* 

Lieutenant  Colonel,  Medical  Corps.  U.  S.  Army,  Washington,  D.  C. 

Pediatrics  as  a specialized  branch  of  medicine  had  no  real  existence 
before  the  middle  of  the  nineteenth  century,  hence  the  literature  of  the 
history  of  the  subject  is  meager.  Its  earlier  history  is  only  a small  part 
of  the  main  current  of  internal  medicine. 

Carl  Hennig’s  introductory  chapter  in  the  Gerhardt  Handbuch  (1879,  I, 
11-50),  the  unsatisfactory  fragment  by  Wolf  Becker  in  the  Puschmann  Handbuch 
(1905,  III,  992-1000),  the  admirable  addresses  of  Theodor  Escherich  and  Abraham 
Jacobi  at  the  St.  Louis  International  Congress  (1905),  the  charming  history  of 
infantile  hygiene  by  Auvard  and  Pingat  (1S89),  S.  S.  Adams’  stud}'  of  American 
pediatric  literature  (1897),  Hermann  Brtining’s  illustrated  history  of  artificial 
nutrition  of  infants  (1908)  and  his  historical  review  of  pediatrics  (with  an  excellent 
bibliography)  in  Brtining  and  Schwalbe's  Handbuch  (1912,  I,  1-20),  Ludwig 
Unger’s  translation  of  Metlinger  (1904),  the  studies  of  Greek  pediatrics  by  T. 
Kroner  (1876-7)  and  J.  W.  Troitzky  (1900),  Sudhoff’s  investigation  of  Cornelius 
Roelants  (1909—15),  Forsyth’s  history  of  infant  feeding  from  Elizabethan  times 
(1910),  Abt’s  history  of  the  classification  of  gastro-intestinal  diseases  (1912), 
Jacobi’s  history  of  American  pediatrics  (1913),  L.  E.  Holt’s  history  of  infantile 
mortality  (1913)  and  Jacobi’s  subsequent  papers  on  pediatrics  in  New  York  City 
(1917)  make  up  almost  the  entire  literature  of  any  importance.  An  indispensable 
bibliography  of  pediatrics  (up  to  1849)  was  published  by  F.  L.  Meissner  in  1850. 
The  full  literature  of  the  subject,  up  to  1898,  is  listed  in  the  Index  Catalogue  of  the 
Surgeon  General’s  Library  under  the  headings  “Children”  and  subdivisions 
(II,  936-957;  2.  series,  III,  422-472);  “Infant  (New-born)”  and  “Infants” 
(VI,  821-860;  2.  series,  VII,  891-930);  and  “Pediatrics”  (2d  series,  XII,  717). 

In  the  present  study  I shall  endeavor  to  outline  the  subject  from  the 
viewpoint  of  the  general  historian  and  bibliographer  rather  than  that  of 
the  professional  pediatrician,  but  I shall  neglect  the  customary  proced- 
ure of  attempting  to  embrace  the  whole  history  of  medicine  in  a narra- 
tive of  this  kind.  There  are  many  things  in  the  secular  and  cultural 
history  of  races  and  nations  which  are  of  great  moment  in  the  history 
of  pediatrics.  But  it  is  reasonable  to  suppose  that  any  well  equipped 
practitioner  or  specialist  of  today  is  acquainted  with  the  general  trend 
of  the  history  of  medicine,  and  my  own  experience  tells  me  that  it  will 
only  impede  his  progress  to  pester  him  with  irrelevant  data  about  the 
past.  Biographical  details  about  earlier  physicians,  whose  relation  to 
pediatrics  was  only  oblique  or  incidental,  will  not  be  given  and  will  be 
otherwise  confined  to  men  who  have  devoted  their  lives  to  the  subject. 

* Published  by  permission  of  the  Surgeon  General,  U.  S.  Army. 

1 


Vol.  I.— l 


2 


HISTORY  OF  PEDIATRICS 


Hennig  has  remarked  that  the  science  of  children’s  diseases  is  the 
last  and  latest  addition  to  the  science  of  disease  in  general.  For  this 
strange  phenomenon  he  assigns  two  causes:  First  the  intimate  relation 
existing  between  mother  and  child  at  the  start,  making  obstetrics, 
gynecology  and  pediatrics  inseparable;  second,  the  difficulties  encoun- 
tered in  recognizing  diseases  in  speechless  young  children  or  in  eliciting 
clinical  information  from  them  before  the  days  of  expert  precision  in 
diagnosis  and  autopsy.*  This  is  a common  excuse  of  all  the  earlier 
pediatricians,  from  Walter  Harris  down.  The  Swedish  bills  of  mortal- 
ity, even  as  late  as  Rosenstein’s  day,  listed  9,783  children  as  dead  “from 
unknown  causes.”  But  a far  more  potent  factor  was  also  operative, 
namely  the  absolute  neglect  of  the  proper  care  and  hygiene  of  infants 
among  savage  and  primitive  peoples  everywhere,  and  even  among 
highly  civilized  peoples  in  the  immediate  past.  Few  realize,  indeed, 
that  it  was  a main  object  of  the  Greeks,  Romans,  Arabians  and 
some  later  peoples  to  destroy  rather  than  to  save  a majority  of  newborn 
infants,  partly  for  economic  reasons,  partly  from  inherent  selfishness. 
It  is  literally  true  that,  among  primitive  races  (in  space)  and  ancient 
peoples  (in  time),  the  newborn  child  was  often  predestined  to  be 
murdered.  Among  modern  “civilized ’’peoples,  for  a long  period,  the 
child,  if  of  poor  or  humble  parentage,  was  predestined  to  be  maltreated, 
starved  and  tortured.  To  appreciate  this  fact,  let  us  glance  at  the 
ethnic  and  social  status  of  the  child  in  space  and  time.  In  all  pre- 
historic and  primitive  phases  of  human  development,  the  child  is 
regarded  as  a negligible  factor.  In  primitive  society,  the  struggle 
for  existence  obtains  in  full  force;  the  individual  is  sternly  sacrificed 
for  the  welfare  of  the  tribe  or  race;  the  strong  wear  down  the  weak; 
the  weakest  inevitably  go  to  the  wall.  Blind  forces  flow,  as  in  physics, 
from  higher  to  lower  potentials.  The  infant,  being  the  weakest  con- 
figuration of  human  protoplasm  conceivable,  stood,  as  Payne  says, 
“naturally  low  in  the  scale  of  value.”f  Among  primitives,  infanticide, 
abortion,  cannibalism  and  ritual  sacrificing  of  children  are  the  rule; 
solicitude  for  their  preservation  is  the  exception.  Savage  children  are 
mutilated  by  tattooing,  scarification  of  the  face  and  body,  artificial 
deformation  of  the  skull,  the  face  or  the  extremities,  and  ritual  opera- 
tion upon  the  genitals.  Twins  are  frequently  killed  as  something 
unnatural  or  uncanny,  or  upon  the  supposition  that  one  of  them  is  a 
sort  of  monstrous  superfetation  from  adulterous  intercourse. 
Children  born  on  “ unlucky  days  ” are  slaughtered,  as  also  children  born 
headfirst  or  in  footlings  presentation,  children  born  with  teeth,  a caul  or 
other  abnormities,  children  born  in  stormy  weather,  children  that 
sneeze  directly  after  birth:  in  fact,  almost  any  pretext  for  infanticide 
is  seized  upon,  in  particular  the  crude  Malthusian  notion  of  limiting 

* C.  Hennig,  Handbuch  der  Kinderkrankheiten  (Gerhardt),  Tubingen,  I 
(1877),  pp.  1-2. 

f G.  H.  Payne,  “The  Child  in  Human  Progress.’’  N.  Y.  (1916),  p.  5.  This 
book,  while  somewhat  one-sided  in  its  enlargement  upon  the  cruelties  practised 
upon  children  through  the  ages,  is  still  a very  valuable  summary. 


HISTORY  OF  PEDIATRICS 


3 


the  population  by  sacrificing  all  children  born  in  excess  of  a statutory 
number  for  a given  family.  The  “ pigeon  pair  ” ( das  Zweikinder system) 
is  as  popular  with  the  savage  as  with  the  civilise  of  today.  It  has  been 
shown  that  prolificity  varies  with  the  amount  of  food-supply  and 
the  productive  value  of  offspring.  Limitation  of  offspring  is  usually 
determined  by  scarcity  of  food  and  creature  comforts,  but  religious 
ardor,  alleged  solicitude  for  the  welfare  of  the  race,  anxiety  lest  the 
child  suffer  as  a charge  upon  the  community,  economic  reasoning, 
have  been  in  each  case  a cloak  for  cruelty  and  murderous  feeling 
in  the  savage  as  in  the  civilized.  The  only  protection  the  child  has 
in  the  savage  state  originates  in  maternal  feeling,  and  the  mother 
is  invariably  subjected  to  the  male.  Prosper  Merimee  observed 
that  “ La  femme  d Vetat  sauvage  est  toujours  laide.”  How  much  more 
is  this  true  of  the  savage  child.  The  distrustful,  sometimes  hostile 
faces  that  look  out  from  the  pages  of  Ploss’s  u Das  Kind ” tell  their  own 
tale.  Girls  had  invariably  a harder  fate  than  boys.  The  story 
of  the  routine  sacrifice  of  female  infants  is  one  of  the  saddest  pages 
in  human  history.  Even  among  the  Greeks  and  the  Romans,  the 
murder  of  children  and  the  glorification  of  the  male  element,  to  the 
exclusion  of  every  thing  else,  localizes  and  diagnoses  a latent  barbarity. 
Plato  said  that  the  foetus  in  utero  was  to  be  regarded  as  an  animal. 
Plutarch  declared  the  destruction  of  one’s  own  children  to  be  ofttimes 
a great  and  virtuous  action.  It  is  significant  that  Egypt  and  Babylon, 
the  two  ancient  civilizations  which  were  kindest  to  children,  were  of 
the  matriarchal  type. 

The  charms  and  taboo  practices  employed  to  ward  off  evil  spirits 
from  the  unborn  child,  such  as  the  couvade,  probably  originated,  not 
from  parental  sympathj'-,  but  from  the  savage’s  innate  fear  of  intan- 
gible evils  and  of  the  unknowable.  Tekonymy,  the  re-naming  of  a 
parent  after  his  newborn  offspring,  does  not  spring  from  regard  for  the 
offspring  but  from  the  inflation  of  parental  self-esteem  upon  possessing 
offspring.  The  various  mutilations  of  the  child’s  body* — boring  holes 
in  the  nose,  lips  and  ears,  flattening  the  nose,  deforming  the  skull,  feet 
and  fingers,  knocking  out  or  sharpening  the  teeth,  circumcision, 
clitoridectomy,  infibulation,  tattooing,  scarification — are  supersti- 
tious rites,  initiating  the  sexual  life,  preparatory  to  marriage,  or 
even  regarded  as  improving  the  child’s  appearance.  All  are  animistic 
in  theory,  but  hardly  expressive  of  human  sympathy.  The  casting  of 
horoscopes  for  the  child,  the  hanging  or  secreting  of  amulets  about  its 
person,  the  planting  of  trees  in  its  favor,  and  similar  rites,  have  the 
same  tendency  and  significance,  f Lane  (Modern  Egyptians)  records 
that  well-to-do  women  of  Egypt  dress  their  children  poorly  and 
shabbily  “to  guard  them  from  the  evil  eye.” 

* On  the  subject  of  artificial  deformation  and  mutilation  of  children  among 
savage  and  civilized  peoples,  see  J.  H.  Porter,  Ann.  Rep.  Smithson.  Inst.  (1887), 
Washington,  II  (1889),  pp.  213-235;  and  A.  Chereau,  Mutilations  ethniques, 
Diet,  encycl.  d.  sc.  med.  (Dechambre),  Paris,  1876,  2,  s.,  xi,  pp.  153-167. 

f See  H.  Ploss,  “Das  Kind,  3 Aufl.”  Leipzig  1911-12.  2 v.,  passim;  and 
Elsie  Clews  Parsons,  The  Family.  N.  Y.,  1906,  pp.  95-111. 


4 


HISTORY  OF  PEDIATRICS 


“The  attitude  of  the  tribe  or  nation  towards  its  young,”  says 
Payne,  “is  also  a barometer  of  progress.”  At  the  beginning  of  his 
book  on  “The  Child,”  he  points  out  that  the  lowest  human  tribes 
are  less  human  in  sentiment  for  their  women  and  their  offspring 
“than  certain  beasts  and  birds.”  “The  instincts  of  the  lower  ani- 
mals,” said  Darwin,  “are  never  so  perverted  as  to  lead  them  to  regu- 
larly destroy  their  own  offspring  or  to  be  quite  devoid  of  jealousy.” 
The  normal  causes  of  infanticide  among  savages  are  either  superstition 
or  fear  of  famine.  The  Papuan  family  is  restricted  to  two  children. 
Infanticide  is  very  prevalent  in  the  coral-reef  islands  of  Polynesia, 
where  the  food  supply  is  always  an  uncertain  quantity.  Twins  are 
immediately  killed  among  the  South  Australians,  Aruntas,  the  Kaffirs 
and  the  West  African  negroes.  It  is  dishonorable  for  women  to  have 
twins  in  the  Benin  territory,  whence  twin-bearing  women  are  roughly 
handled.  In  more  specialized  communities,  children  are  sacrificed 
as  an  offering  to  the  gods.  Here  religion  becomes  a kind  of  sanctioned 
blackmail  of  humans  by  gods  and  their  organized  votaries,  or  else  a 
cloak  for  fanatical  self-exploitation  or  some  equally  selfish  end.  The 
real  reason  is  that  there  is  not  enough  food  to  go  around.  To  nomadic 
tribes,  indeed  to  all  whose  principle  of  action  is  Kipling’s  “He  travels 
fastest  who  travels  alone,”  children  are  invariably  an  encumbrance. 
In  old  and  (up  to  recent  times)  almost  stationary  civilizations,  such 
as  China,  India  and  Japan,  infanticide,  the  routine  sacrifice  of  female 
children  and  the  selling  of  children  into  slavery  were  consequent 
upon  the  deposal  of  the  primordial  matriarchate,  and  grew  with  in- 
creasing density  of  the  population  or  latterly  with  occasional  periods 
of  famine  and  privation.  In  China,  the  drowning  of  infants,  especially 
female  infants,  is  still  prevalent  in  spite  of  endless  imperial  edicts. 
The  Jesuits  record  that  up  to  232  B.C.,  children  were  an  asset,  the 
orphan  could  choose  his  adoptive  parents  and  there  was  no  trace  of 
drowning,  exposure  or  abandonment.  With  Confucius  arose  the  idea 
of  male  sovereignty,  with  the  child  as  a subject  or  chattel.  Under  Tsin 
Chi  Hoang  (232  B.C.),  war  and  famine  led  to  the  practice  of  abandon- 
ment and  to  the  drowning  of  female  infants.  In  the  first  official 
document  against  infanticide  (1659),  an  edict  of  Choen  Tche  (1633-62), 
we  read: 

I have  heard  that  the  sad  cry  uttered  by  these  girl  babies  as  they  are  plunged 
into  a vase  of  water  and  drowned  is  inexpressible.  Alas!  that  the  heart  of  a father 
or  mother  should  be  so  cruel.  * 

Subsequent-  decrees  of  1773,  1815,  1845,  and  1848  proved  of  little 
avail,  owing  to  the  scarcity  of  food  in  relation  to  the  density  of  the 
population.  Some  writers  estimate  that  from  25  to  40  per  cent, 
of  female  infants  are  drowned  annually  but  the  practice  is  slowly  dying 
out  in  most  localities.  In  ancient  Japan,  the  sons  of  a polygamous 
father  were  natural  enemies  and  had  no  claim  upon  him.  Human 

sacrifice,  e.g.,  to  insure  that  the  foundations  of  a building  might  be 

be  =i  ‘ . ..rv •;  ' . . : 1 • ..  . 


Cited  bv  Pavne. 


HISTORY  OF  PEDIATRICS 


5 


“well  and  truly  laid,”  was  abolished  about  3 B.C.,  but  famine  some- 
times produced  cannibalism,  and  children  were  legally  punished  as  scape- 
goats for  the  crimes  of  their  parents  up  to  the  end  of  the  seventeenth 
century.  Chinese  ideas  and  ideals  gained  ascendency  about  552  A.D., 
and  after  Confucius  came  the  deposal  of  the  matriarchate  by  the 
Samurai  and  the  sacrifice  of  children  to  the  welfare  of  their  parents. 
There  were  eight  enactments  against  the  sale  of  children  between  1624 
and  1734.  The  Japanese  are  fond  of  children  and  have  no  such  intense 
dislike  for  girls  as  the  Chinese,  nor  is  the  population  so  dense,  yet  many 
children  were  sold  during  the  famine  of  1905  and  infanticide  is  said  to 
have  been  prevalent  in  connection  with  the  high  taxes  following  the 
Russo-Japanese  War.  In  ancient  India,  the  Aryans,  originally  an 
agricultural  people,  later  a race  of  fanatical  warriors,  desired  male 
children  to  increase  the  fighting  capacity  of  the  tribe.  Male  children 
became  part  of  the  scheme  of  wealth.  Females  were  preserved  for 
procreative  purposes  only.  The  Laws  of  Manu  declare  that  “Women 
are  born  to  bear  children.”  The  slaughter  of  unnecessary  children 
was  sanctified  in  the  Mahabharata.  The  ancient  rituals  show  that 
female  children  were  doomed  at  birth.  Female  infanticide  was  held  to 
be  of  divine  origin;  the  real  reason  for  its  existence  was  economic. 
The  chief  end  of  Aryan  man  being  to  feed  himself  by  predatory  wars 
and  to  breed  soldiers  for  this  end,  women  were  only  tolerated  in  num- 
bers sufficient  for  this  purpose.  Female  infanticide,  like  the  suttee 
custom,  was  highly  prevalent  in  eighteenth  century  India.  The 
attempt  of  Colonel  Alexander  Walker  to  suppress  it,  in  1805,  led  to  a 
long  correspondence  of  80  years  duration,  in  which  the  Indian  princes 
protested  vigorously  against  interference  with  their  religious  and  social 
ideas  of  4900  years  standing.  The  Infanticide  Act  of  1871  was  the 
final  effort  of  government  to  suppress  the  practice.  The  ancient 
practice  of  sacrificing  the  first  born  for  ritual  reasons  is  familiar  in  the 
Biblical  stories  of  Abraham  and  Isaac  and  the  daughter  of  Jephthah. 
The  Arabians,  a nomadic  desert  people,  sacrificed  their  infant  and  even 
adult  daughters  by  burying  them  alive,  until  the  practice  was  suppressed 
by  Mohammed.  The  Greeks,  in  some  respects  the  most  intelligent 
people  the  world  has  known,  were  utterly  callous  about  the  fate  of 
children  foredoomed  to  exposure  by  economic  conditions  or  by  the 
shame  of  pregnancy  in  unmarried  women. 

But  there  is  a good  deal  of  human  nature  in  the  world  and  we  must 
not  neglect  the  brighter  side  of  the  picture.  The  civilizations  of 
Egypt  and  Babylon,  being  centered  in  fertile,  plenteous  lands,  and 
matriarchal  in  type,  were  as  we  shall  see,  reasonably  fair  and  decent  to 
the  child.  This  was  perhaps  also  true  of  the  Minoan  civilization  of 
Crete,  the  presiding  deity  of  which  was  a primordial  mother-goddess. 
There  is  sufficient  evidence  that  such  children  as  were  permitted  to 
survive  under  stress  of  economic  conditions  were  not  inhumanly 
treated,  even  among  savages,  although  there  is  little  evidence  of  an 
active  sympathy  for  children.  Stevenson  said  that  the  South  Sea 
Islanders  who  practice  infanticide  and  are  capable  of  selling  their 


6 


HISTORY  OF  PEDIATRICS 


children  into  slavery  are  yet  affectionate  and  patient  with  them.* * * § 
Not  all  of  ancient  Greece  was  given  over  to  infanticide  and  exposure. 
Julian  records  that  in  Thebes  these  offences  were  punished  by  death.  | 
Mahaffy  thinks  that  the  Greek  practice  of  exposure  of  infants  arose  in 
a late  period,  and  from  economic  motives  in  an  overcrowded  civiliza- 
tion.:!; In  evidence,  he  cites  the  instances  of  sympathy  for  children  in 
Homer,  Herodotus,  Euripides  and  Thucydides. § In  the  sixth  Iliad, 
there  is  the  affecting  farewell  of  Hector  and  Andromache.  The  hero 
bewails  the  impending  fate  of  his  wife  and  child,  and  tenderly  lays  aside 
his  helmet  lest  the  infant  Astyanax,  “fair  as  a star,”  be  frightened  at 
his  nodding  crest.  In  the  subsequent  lament  of  Andromache  over  the 
body  of  Hector,  she  bewails  her  widowhood  and  mourns  the  hard  fate 
in  store  for  her  defenceless  child. 

Women,  particularly  great  ladies  like  Helen,  Andromache,  Hecuba, 
Penelope,  were  held  in  high  esteem  by  the  Homeric  Greeks  and  their 
children  no  less.  There  is  evident  tenderness  for  child-life  in  the 
similes  of  the  Homeric  poems.  In  the  fourth  Iliad  (20),  Minerva  repels 
the  arrow  shot  at  Menelaus  “as  a mother  drives  away  a fly  from  her 
child  when  it  lies  in  sweet  sleep.”  In  the  fifteenth  Iliad  (361),  Apollo 
overthrows  the  earthworks  of  the  Greeks  as  easily  as  a child  playing 
by  the  sea  tumbles  the  sandheaps  it  has  made.  At  the  beginning  of 
the  sixteenth  Iliad,  Achilles  addresses  the  weeping  Patroclus  with 
winged  words: 

“Why  weepest  thou,  O Patroclus,  like  an  infant  girl,  who  running  along  by 
her  mother,  begs  to  be  taken  up,  and  holding  on  by  her  dress,  delays  the  hurrying 
woman,  and  looks  at  her  with  her  eyes  full  of  tears,  in  order  that  she  may  be  taken 
up  and  carried.” 

Mahaffy  emphasizes  the  strong  love  of  children  in  the  anecdotes  of 
Herodotus,  which  sympathy  is,  in  all  likelihood,  “his  own  or  that  of  his 
age,  even  though  the  naked  facts  may  be  the  heritage  of  a previous 
society.”  When  the  oligarchs  of  Corinth  sent  ten  of  their  number, 
in  deference  to  the  oracle,  to  destroy  Cypselus,  the  child  of  Eltion, 
the  mother,  Labda,  unaware  of  their  intentions,  placed  the  infant 
in  the  hands  of  one  of  them;  but  its  smile  was  so  beautiful  that  the 
oligarch  could  not  summon  brutality  to  dash  out  its  brains,  so  handed 
it  to  the  second,  he  to  the  third,  until  it  passed  through  their  ten  hands 
unscathed.  When  they  finally  resolved  to  accomplish,  the  deed,  the 
mother  had  safely  hidden  the  child  in  a chest,  and  after  a half-hearted 
search,  they  returned  to  say  that  they  had  done  all  that  had  been 
commanded  (V,  92).  Elsewhere,  he  tells  how  a house  in  Chios,  “fell 
in  upon  some  boys  as  they  wTere  learning  to  read,  so  that  of  one  hundred 
and  twenty  boys  only  one  escaped”  (VI,  27).  In  another  place,  he 

* Payne,  op.  cit.,  p.  44. 

f .Elian,  Varia  Hist.,  ii,  p.  7.  Cited  by  Lecky. 

t J.  P.  Mahaffy,  “Social  Life  in  Greece  from  Homer  to  Menander.”  London 
(1913),  p.  165. 

§ Ibid.,  pp.  163-169. 


HISTORY  OF  PEDIATRICS 


7 


describes  a Spartan  nurse  standing  before  the  temple  of  Helen  to  pray 
that  the  goddess  might  make  an  ugly  infant  beautiful  (VI,  61).  Aris- 
totle relates  that  when  the  oracle,  in  punning  fashion,  commanded  the 
Malians  to  love  the  dearest  of  the  dear  (tfiiXeiv  riov  (PlXtcxtov  ra  (pLXraTa) , 
they  carried  their  naked  infants  about  at  feasts  and  kissed  them. 
Themistocles,  in  Plutarch’s  Lives,  declares  that  “his  boy,  who  bullied 
his  mother,  was  the  greatest  power  in  Greece:  For  the  Athenians  ruled 
the  rest  of  Greece,  Themistocles  ruled  the  Athenians,  his  wife  ruled 
him,  and  his  boy  ruled  her.”  In  the  tragedies  of  Euripides,  children 
appear  upon  the  stage  to  heighten  the  pathos  of  a situation.  In 
Thucydides  (VII,  29),  it  is  said  that  the  massacre  of  a whole  school  of 
little  boys  at  Mycalessus  by  a band  of  Thracian  mercenaries  was 
regarded  as  the  outstanding  instance  of  frightfulness  in  the  whole 
Peloponnesian  war,  although  in  Mahaffy’s  view,  the  cold  historian 
conceals  his  own  emotions  “under  the  most  violent  contortions  of 
grammar.”*  There  is  thus  abundant  evidence  of  a tender  regard 
for  children  in  the  ancient  Greek  civilization,  in  spite  of  the  fact  that 
exposure  of  infants  was  common  at  Athens,  and  was  justified  and 
almost  defied  in  poetry  and  the  drama,  as  being  the  lot  of  Zeus,  Po- 
seidon, Hephaestus,  Aesculapius,  Atalanta,  Ion,  Amphion  and  (Edipus. 
Let  us  remember,  also,  that  it  is  precisely  in  Greek  medicine  that  we 
find  the  only  scientific  body  of  pediatric  literature  of  value  before  the 
advent  of  the  masters  of  the  eighteenth  and  nineteenth  centuries. 

Christianity  and  its  votaries  undoubtedly  did  much  to  elevate 
the  status  of  the  child  and  to  remove  its  social  disabilities.  The 
figures  of  the  Madonna  and  the  Christ  Child  were  enshrined  in  mediae- 
val art;  but  it  is  not  until  the  middle  of  the  nineteenth  century  that 
we  find  any  artistic  and  human  feeling  comparable  with  that  of  the 
Greeks.  In  modern  civilization,  the  child  is  explicitly  “the  father  of 
the  man,”  the  expression  of  the  continuity  of  the  germ-plasm,  the 
means  whereby  the  individual  projects  and  propagates  himself  or 
herself  into  futurity.  Ours  is  “The  century  of  the  child,”  a result 
partly  due  to  art,  partly  to  science  and  scientific  legislation.  About 
this  tiny  figure  have  clustered  and  concentrated  all  things  that  differ- 
entiate the  altruistic  from  the  self-regarding  feelings,  the  best  ethical 
ideas  and  sentiments  in  regard  to  the  proper  relations  between  men 
and  women,  the  noblest  aspirations  of  our  time  toward  humanitarian 
and  social  legislation,  some  of  the  finest  inspirations  of  poets,  artists  and 
musicians.  The  religious  and  legal  sanctions  of  marriage  exist  solely 
for  the  benefit  and  protection  of  the  child,  only  incidentally  for  the 
“respectability”  of  the  contracting  parties.  With  Rousseau’s  Emile 
(1762),  a whole  species  of  secular  literature  about  children  came 
into  being,  something  which,  in  the  past,  had  only  existed  in  spots, 
as  among  the  Greeks  or  in  the  episode  of  Mamilius  in  Shakespeare  (A 
Winter’s  Tale).  After  the  long  nightmare  of  the  French  Revolution 
and  the  Napoleonic  Wars,  there  was  an  actual  springtide  of  hope  and 
aspiration  for  European  humanity.  Poets  of  liberty  arose — Shelley, 
* Mahaffy,  op.  tit.,  p.  168. 


8 


HISTORY  OF  PEDIATRICS 


Byron,  Wordsworth,  Landor,  Hugo,  Swinburne — champions  of  liberty 
and  liberal  legislation,  such  as  Stuart  Mill,  Beaconsfield,  Peel,  Glad- 
stone, Louis  Blanc,  Armand  Carrel,  Mazzini,  Kossuth — humanitarian 
novelists  like  Dickens,  Charles  Reade,  Victor  Hugo — everywhere,  in 
fact,  there  was  an  upspringing  of  liberal  sentiment  and  philanthropy. 
English  labor  legislation  began  in  1802  (Peel  Act),  child  legislation 
in  1836.  Victor  Hugo’s  great  prose  epic  on  the  miseries  of  the  poor 
(Les  Miserables ) was  completed  in  1862.  Three  years  later,  the  loi 
Roussel  was  passed  (1865).  Charles  Dickens,  whom  Swinburne  called 
“the  greatest  Englishman  of  his  time,”  fought  with  tongue  and  pen 
for  the  rights  of  the  child,  to  whom  he  devoted  some  of  the  choicest 
fantasies  of  his  genius.  Poetry  about  children  culminated  in  such 
exquisite  things  as  Victor  Hugo’s  L’art  d’etre  grand-pere,  Longfellow’s 
Delia  and  The  Children’s  Hour,  Stevenson’s  A Child’ s Garden  of  Verses, 
and  the  dainty  lyrics  of  Swinburne  and  Sir  Rabindranath  Tagore. 
The  disabilities  cast  upon  girls  by  female  infanticide  in  the  past  have 
completely  disappeared.  The  process  of  deification  began  with 
Dante’s  Beatrice.  Goethe’s  Mignon,  Dicken’s  Little  Nell,  Dr.  John 
Brown’s  Marjorie  Fleming,  Victor  Hugo’s  Cosette,  linger  in  the 
memory  as  figures  of  essentially  modern  interest.  The  systematic 
spoiling  of  young  women  by  cheap  flattery  and  ill-considered  adulation 
is  a specific  feature  of  recent  life  and  of  the  more  ephemeral  sort  of 
modern  literature.  The  net-result  has  been  to  make  the  young  person, 
in  Boyesen’s  phrase,  “a  perfect  little  monster  of  human  selfishness.” 
The  feeling  of  Andrea  del  Sarto,  Correggio,  Rubens  and  Vandyke 
about  the  child  in  painting  has  been  revived  in  many  modern  canvasses. 
In  music,  such  preludings  as  Haydn’s  Toy  Symphony,  Schumann's 
Scenes  of  Childhood  and  his  Album  for  the  Young  were  followed  bjr 
endless  imitations,  even  at  the  hands  of  Brahms,  Tschaikowsky  and 
Debussy.  Schumann’s  “Requiem  for  Mignon”  and  Louis  Ehlert’s 
“Requiem  for  a Child”  are  examples  of  another  genre.  The  child  in 
folk-song  is  a modern  revival.  The  cradle  songs  of  Chopin,  Grieg, 
Wagner  and  Brahms  are  full  of  poetic  charm.  The  “Adventures  in  a 
Perambulator,”  an  orchestral  suite  by  John  Alden  Carpenter,  of  Chicago, 
is  a most  delightful  specimen  of  American  music.  Richard  Strauss  has 
apotheosized  the  baby  as  the  tyrant  of  the  household  in  his  “ Sym- 
phonia  Domestica,”  the  squallings  of  the  infant  being  rendered  for- 
tissimo by  the  full  orchestra.  To  the  old  folk-tales  of  the  past  have 
been  added  Grimm,  Hans  Andersen  and  hosts  of  later  things.  Every 
Christmas  brings  out  a flood  of  books,  pictures  and  music  about 
children.  Thus  the  glorification  of  the  child  in  modern  life  has  been 
due  to  the  artists,  the  poets,  the  writers,  the  musicians,  rather  than  to 
the  statists,  philanthropists  and  legislators. 

Let  us  now  consider  the  status  of  the  child  in  folk-medicine. 
From  the  moment  of  conception,  the  infant,  born  or  unborn,  is 
thought  to  be  exposed  to  a swarm  of  evil  demons  who  may  inflict  a 
disease  or  malformation  upon  the  helpless  child,  or  substitute  one  of 
their  own  brood  for  it  as  a changeling,  and  thus  make  it  a cretin 


HISTORY  OF  PEDIATRICS 


9 


or  other  monster  (Ploss) . * Witches  and  sorcerers  may  cast  spells  upon 
it  or  it  may  be  subjected  to  the  influence  of  the  evil  eye.  Against 
these  malign  influences,  all  sorts  of  charms,  amulets,  talismans,  incan- 
tations and  spells  are  employed,  the  varied  ritual  of  which  makes  up  a 
large  part  of  ethnic  folklore.  An  equally  complex  and  variegated 
ritual  presides  over  the  bathing,  washing,  swaddling,  cradling,  nursing, 
wet-nursing,  artificial  feeding,  naming,  baptism  and  carrying  of  the 
newborn  infant  among  different  peoples.  These  practices  have  been 
described  in  detail  by  Ploss  {Das  Kind). f The  care  of  the  sick  child  in 
the  savage  and  semi-civilized  state J forms  another  large  chapter  of 
anthropology.  Apart  from  actual  infanticide,  the  high  mortality  of 
infants  and  children  among  savage  and  primitive  peoples  is  due 
mainly  to  one  set  of  causes:  Total  ignorance  of  the  proper  care  and 
hygiene  of  children,  mental  inability  to  evolve  a proper  hygienic 
scheme,  with  the  natural  indifference  resulting  from  this  state  of 
mind.  Primitive  pathology  invariably  assigns  demons,  magicians, 
witches  and  angered  gods  as  the  efficient  causes  of  disease,  adult 
or  infantile.  Primitive  therapy  professes  to  dispose  of  these  by 
prayers,  incantations,  charms  and  other  manoeuvres  of  the  medicine 
man.  In  Imeretia  (Caucasus),  the  mother  of  a sick  child  walks 
thrice  around  its  bed  and  then  prays  upon  her  knees  that  the  malig- 
nant batoneti  will  take  her  soul  rather  than  her  child’s;  prayers  are 
offered  by  the  father,  and  oxen,  fowls  or  pigs  are  allowed  to  wander 
away  as  an  offering  to  the  demon.  In  the  lower  Congo  region,  a 
family  consultation  is  held  over  the  sick  child,  and  a magician  is  sum- 
moned, whose  diagnosis  is  inevitably  “witchcraft.”  Among  the 
Wahehe  (East  Africa),  if  a sick  child  does  not  get  well,  a soothsayer 
{mlagasi)  is  summoned,  who,  after  learning  the  probable  amount  of 
his  fee,  moves  an  inverted  mortar  over  the  top  of  a stool,  repeating  a 
litany  of  diseases  the  while;  the  mortar  stops  when  he  achieves  his 
diagnosis,  which  is  further  confirmed  by  revolving  a horn  about  a stick, 
until  it  stops  at  the  name  of  the  presumable  disease  (Ploss).  In 
England,  Ireland,  France  and  Germany,  sick  or  rachitic  children  are 
passed  through  clefts  or  arching  roots  of  trees,  holes  in  large  stones  or 
other  rocky  formations,  bell-ropes,  ladders,  etc.  This  is  also  a remedy 
for  infantile  hernia.  Infantile  convulsions  (“ Fraisen”)  are  suppressed 
in  Silesia  by  placing  the  mother’s  engagement  ring  or  her  bridal  crown 
in  the  child’s  bed;  in  Bohemia,  by  administering  milk  mixed  with  soot 
from  a candle-snuffer,  or  three  cinders  from  the  hearth,  in  the  name  of 
the  Holy  Trinity;  in  Moravia  by  casting  a garment,  snatched  from  the 
child’s  body,  into  a rapidly  flowing  stream;  in  Upper  Austria  by 
winding  yarn,  spun  by  a girl  of  seven,  about  the  infant’s  neck.  In 

* H.  Ploss,  Das  Kind  im  Brauch  und  Sitte  der  Volker,  3 Aufl.  Leipzig,  i, 
(1911),  p.  100. 

f Ibid.,  pp.  211-514,  passim. 

t The  details  in  this  section  are  taken  mainly  from  the  chapter  "Das  kranke 
Kind”  in  Ploss.  op.  cit.,  515-547.  The  subject  is  even  more  elaborately 
treated  in  Hovorka  and  Kronfeld:  Vergleichende  Volksmedizin,  Stuttgart,  1909,  ii, 
pp.  632-718. 


10 


HISTORY  OF  PEDIATRICS 


Lower  Austria,  talismanic  necklaces  are  employed;  in  Moravia  and 
Styria,  little  helmet-shaped  caps  ( Fraisenhauben ) decorated  with 
religious  emblems,  are  worn;  in  Styria,  again,  a “convulsion-clock” 
(Fraisenuhr)  is  wound  up  and  chimes  at  intervals  during  the  attack.* 
Among  English  folk-remedies  for  whooping  cough  in  children  are 
passing  the  child  underneath  animals  or  bushes,  carrying  it  through 
a cloud  of  smoke,  placing  a live  frog  or  the  head  of  a trout  in  the  child’s 
mouth,  giving  it  a soup  cooked  over  a stream  flowing  from  north  to 
south,  passing  a tarred  bandage  around  its  neck,  administering  a 
roasted  mouse  or  owl  broth,  or  holding  a decrepid  spider  over  the 
patient’s  head  while  repeating  the  charm: 

“ Spider,  as  you  waste  away, 

Whooping  cough  no  longer  stay.” 

Malaria,  as  we  read  in  “Evangeline,”  was  “cured  by  wearing  a spider 
hung  round  one’s  neck  in  a nutshell.”  In  Scotland,  a consumptive 
child  is  passed  through  a wreath  of  woodbine,  and  on  Mayday,  sick 
children  are  taken  to  healing  wells.  In  the  Transvaal,  Franks  saw 
three  sick  children,  painted  green  all  over,  with  the  exception  of 
their  faces,  and  all  these  succumbed  to  arsenic  poisoning.  The  same 
observer  saw  a Boer  mother  give  successively  to  a two  year  old  child 
Hoffmann’s  drops,  an  opiate,  a red  powder  containing  tartar  emetic, 
Jamaica  ginger  and  Holland  drops.  Woodroffe  prescribed  for  a Boer 
child,  whose  mother  subsequently  obtained  another  prescription  from  a 
second  physician,  in  order  to  experiment  with  the  two  in  succession. 
Cassia  fistula  and  rhubarb  are  favorite  infantile  purgatives  among 
primitive  peoples.  Clysters  and  vegetable  emetics  are  frequently 
employed.  The  Zulus  in  Natal  give  the  newborn  a perfunctory  clyster 
of  the  juice  expressed  from  the  roots  of  the  “amasabele”  (Euphorbia 
pugniformis) , in  warm  milk,  in  order  to  “purify  the  stomach.”  As  a 
vermifuge,  they  employ  a decoction  of  “incamu”  (Othonna  natalensis) . 
The  use  of  opiates  to  quiet  fretful  infants  is  deplorably  wide-spread 
among  all  peoples,  savage,  peasant  or  civilized.  The  exhibition  of  opium 
to  stop  a child’s  crying  is  as  old  as  the  Ebers  Papyrus. f Syrups  and 
decoctions  of  poppies  or  hyoscyamus  are  of  common  use  for  this 
purpose  in  the  Orient,  whence  the  pernicious  custom  spread  among  the 
Persians,  Tartars  and  Armenians,  and  thence  to  Russia,  the  Germanic 
countries  and  the  British  Isles.  Even  in  the  forms  known  to  city 
dwellers,  as  paregoric,  soothing  syrup,  “Godfrey’s  Cordial,”  “Mother’s 
Blessing,”  “Dalby’s  Carminative,”  etc.,  the  exhibition  of  opium  in 
teething  and  night-fears  of  infants  is  an  almost  universal  folk-remedy,! 
which  has  led  some  anthropologists  to  derive  it  primarily  from  folk- 
intuition.  To  explain  the  genesis  of  intuitive  folk-therapy,  Hovorka 
postulates  certain  “laws  of  congruence,”  in  virtue  of  which  primitive 

* Hovorka  and  Kronfeld,  Vergleichende  Volksmedizin,  Stuttgart  (1909),  ii, 
pp.  674-684,  passim. 

f See  H.  E.  L.  Luring,  “Die  iiber  die  medicinischen  Kenntnisse  der  alten 
Aegypter  berichtenden  Papyri.”  Strassburg  dissertation.  Leipzig  (1888),  p.  45. 

t Ploss,  op.  cit.,  pp.  531-533. 


EGYPT 


11 


man  everywhere  sought  identical  remedies  instinctively  for  certain 
affections,* * * §  but  the  real  explanation  of  “doping”  the  children  is  that 
the  practice  originated  in  the  East,  where  the  poppy  abounded  in 
nature.  In  therapeutics,  however,  the  folk-mind  has  a notable  tend- 
ency to  favor  the  doctrine  of  “like  cures  like,”  e.g.,  a drowsy  syrup  for  a 
disorder  of  sleep.  But,  as  a rule,  the  primitive  doctor,  vaguely  sensing 
the  fact  that  time  and  nature  are  often  the  best  remedies,  seeks  every 
excuse  for  temporizing,  and,  in  his  attempt  to  “explain”  the  phe- 
nomena of  disease,  is  easily  led  away  into  animism  and  mysticism. 

The  bad  and  sometimes  fatal  effects  of  the  exhibition  of  opium  in 
infants  were  early  noted  by  Walter  Harris  (1689)  and  were  described 
in  impressive  manner  by  the  English  physiologist  Marshall  Hall 
(1885), f hut  his  essay  did  little  to  check  this  abuse.  Some  English 
druggists  are  said  to  have  purchased  over  200  pounds  of  opium  annually 
for  this  purpose,  and  in  one  district  an  annual  dispensation  of  100  grains 
per  caput  was  estimated.  X 

We  are  now  in  position  to  review  the  history  of  pediatrics  in  the 
written  and  printed  texts,  beginning  with  the  hieroglyphic  and  cunei- 
form inscriptions. 


EGYPT 

In  Ancient  Egypt,  the  military  and  priestly  castes  existed  as  beings 
set  apart  for  sacred  functions:  The  lot  of  the  toilers,  those  in  whom 
the  hand  was  subdued  to  the  material  it  worked  in,  was  as  that  of  the 
craftsmen  in  Ecclesiastes:  “They  shall  not  be  sought  for  in  public 
counsel,  nor  sit  high  in  the  congregation;  they  shall  not  sit  on  the 
judges’  seat.”  Neuburger  cites  an  early  Egyptian  sentence  about  the 
working  classes:  “The  child  is  procreated  only  to  be  torn  from  its 
mother’s  arms — if  he  arrives  at  manhood,  his  bones  are  broken  as  those 
of  an  ass.”§  But  the  civilization  of  Egypt  was  of  matriarchal  type. 
The  mother-goddesses  Hathor,  Mut,  and  Neith,  deifying  the  creative 
power  of  nature,  the  nature  goddesses  Anquet  (fructifying  power  of 
Nile),  Bast  (fructifying  heat  of  the  Sun),  the  pregnant  cow-goddess 
Mehurt  (female  creative  principle),  Nephthys  (decay,  death  and 
immobility),  Nut  (Night),  Satet  (inundation  of  the  Nile),  Sekhet 
(destructive  heat  of  the  Sun),  Tefnut  (rain),  also  the  birth  goddesses 
Nekhebet  and  Taurt,  who  presided  over  obstetric  functions,  Mesk- 
henit,  who  appeared  at  the  child’s  cradle  and  Rannut  who  presided 
over  the  harvests,  maternity  and  nursing,  all  bespeak  the  strength 
of  the  female  and  maternal  element  in  the  Egyptian  pantheon.  Isis 
the  sister-spouse  of  Osiris,  the  type  of  the  faithful  wife  and  mother,  is 
usually  represented  in  the  act  of  suckling  Osiris.  Women  in  the  mural 

* O.  von  Hovorka,  Mitt.  d.  anthrop.  Gesellsch.  in  Wien,  1915,  xlv,  pp.  125-136. 

f Hall,  “Practical  Observations  and  Suggestions  in  Medicine.”  London 
(1845),  pp.  174-176. 

t Ploss,  op.  tit.,  p.  532. 

§ Neuburger,  Geschichte  der  Medizin,  Stuttgart,  i,  (1906),  p.  52. 


12 


HISTORY  OF  PEDIATRICS 


decorations  and  figurines  are  nearly  always  of  comely,  attractive 
semblance,  and  in  the  family  groups  there  is  every  sign  of  affection. 
In  the  earlier  Egyptian  civilization,  there  are  some  evidences  of  human 
sacrifice,  but  no  indications  of  "infanticide,”  or  maltreatment  of 
children.  Egypt  was  a land  of  plenty,  and  children  were  well  taken 
care  of.  Aristotle  says  explicitly  that  the  Egyptian  women  bore 
many  children  and  that  all  children  born  into  life  were  well  brought 
up.  Diodorus  Siculus  (1st  century,  B.C.)  records  (I,  20)  that  the 
children  of  ancient  Egypt  were  clothed  and  reared  at  a very  trifling 
expense.  He  says  of  the  ancient  Egyptians  that  those  who  killed  their 
children  were  not  executed  themselves,  but  were  condemned  to  hug 
their  dead  offspring  continually  in  their  arms  for  three  days  and  three 
nights,  in  order  to  experience  their  full  deserts  of  horror  and  remorse 
(I,  6).*  The  items  listed  in  Sudhoff’s  Catalogue  of  the  Historical 
Section  of  the  Dresden  Hygienic  Exposition  (1911)  suggest  a highly 
specialized  civilization  with  plenty  of  creature  comforts. 

The  mural  reliefs  and  frescoes  from  the  temples  show  the  threshing  of  grain 
(items  1101-8),  the  kneading  of  dough  (1109-11),  the  harvesting  of  figs  (1118', 
a market  scene  of  the  Old  Empire,  with,  stands  for  fish,  vegetables,  a fish-pond  with 
ducks,  in  a rich  park  (1131),  milking  a cow  (1162),  a child  suckled  directly  from 
the  udders  of  the  cow-goddess  Hathor  (1163),  vintage  and  wine-making  (1173-77), 
brewing  beer  (1178-84),  a dining  table  set  for  the  dead  (1193),  beds  and  wooden 
head-rests  (1225-35),  vanity  cases  (1307),  manicures  (1310),  cosmetics  (1311-12), 
combs  (1323-5),  mirrors  (1327-9),  razors  (1331-48),  a woman  prinking  herself 
with  cosmetics  before  a mirror  (1354),  bathing  in  common  (1397),  the  complaint  of 
a Greek  woman  to  Ptolemy  (220  B.C.)  that  she  had  been  parboiled  in  her  bath  by  a 
careless  attendant  (1410),  the  accouchement  of  a queen  on  an  obstetric  chair, 
attended  by  four  midwives  (1423),  Isis  suckling  and  dandling  Horus  (1425-31), 
modes  of  carrying  children  (1432-38),  dolls  and  balls  of  600  B.C.  (1439),  children’s 
games  (1440-42),  dancing  (1443-45),  statues  of  physicians  (1496-99),  amulets  and 
scarabs  (1502-14);  Horus  as  averter  of  a pathogenic  worm  (1515);  apotropaic 
reliefs  of  the  child  Horus  against  vermin  (1516,  1518,  1523);  a court  official  with  a 
fly-flap  (1524);  aboriginal  Egyptian  rites  for  cult-cleanliness  (1525);  the  interment 
of  a child’s  corpse  in  a bed  (1534),  coffins,  burial-rites,  sarcophagi  and  mummies 
(1530-1632),  and  pathological  preparations  from  diseased  mummies  (1630-1728 

At  birth,  the  Egyptian  infant  was  not  constricted  in  swaddling 
clothes  but  allowed  to  run  about  naked  or  carried  about  in  loose,  soft 
wrappings.  After  weaning,  its  diet  was  cow's  milk  only,  later  vege- 
table foods  and  water.  It  led  a wholesome  healthy  existence  in  the 
open  air,  completely  naked  up  to  five,  barefoot  up  to  ten,  playing  with 
hoops,  balls  and  dolls  before  taking  up  the  “three  R’s”  in  school 
(Neuburger)4  Ritual  circumcision  was  performed  upon  boys  of  the 
priestly  and  warrior  castes  with  a flint  knife.  Self  abuse  is  named  as  a 
vice  in  the  Book  of  the  Dead. 

Of  Egyptian  medicine,  Homer  saj^s  (Odyssey  IV,  220-223):  "There  the  fruitful 
earth  brings  forth  many  drugs,  many  excellent  when  mingled,  and  many  fatal; 

* Diodorus  Siculus  Historical  Library,  transl.  by  Booth:  Yol,  1,  par.  6,  p.  79. 
Cited  by  Payne. 

f “Internationale  Hygiene- Ausstellung.”  Dresden  (1911).  “Historische  Ab- 
teilung,”  2.  Aufl.  Dresden  (1911),  pp.  33-54,  passim. 

t Neuburger,  op.  cit.,  p.  52. 


EGYPT 


13 


there  every  physician  is  skilled  above  all  men;  for  truly  they  are  of  the  race  of 
Paeon.  ” 

Medicine  in  Egypt,  as  Herodotus  tells  us, was  specialized  to  the  extent 
of  having  a doctor  for  every  disease.  A set  line  of  treatment  was 
prescribed  and  if  the  patient  died  from  any  deviation  from  standardized 
practice,  the  physician  was  put  to  death;  although  in  the  time  of 
Aristotle,  a change  of  therapy  was  permissible  after  the  fourth  day, 
if  the  patient  did  not  improve. 

The  principal  sources  of  Egyptian  medicine  are,  in  order  of  antiquity,  the  badly 
preserved  London  Papyrus,  edited  and  translated  by  Walter  Wreszinski  (1910), 
the  Westcar  (Lesser  Berlin)  papyrus,  translated  by  Adolf  Erman  (1890),  the 
Brugsch  (Greater  Berlin)  papyrus,  translated  by  Wreszinski  (1909),  the  Papyrus 
Ebers,  translated  by  H.  Joachim  (1890),  the  Hearst  (Philadelphia)  papyrus, 
containing  about  one  half  the  Papyrus  Ebers  and  the  Kahun  papyri  of  the  Petrie 
Collection,  translated  by  F.  L.  Griffiths  (1893).  Of  principal  interest  for  Egyptian 
pediatric  lore  are  the  Lesser  Berlin  and  the  Ebers  papyri. 

The  Lesser  Berlin- Papyrus,  or  Papyrus  of  the  Mother  and  Child 
(16th  Century  B.C.)  is,  for  the  most  part,  made  up  of  wonder  tales 
and  magic  charms.  It  contains  only  three  prescriptions.  Holmes 
cites  a charm  to  be  recited  over  a string  of  three  beads  (lapis  lazuli, 
jasper,  malachite)  to  be  hung  about  the  neck  of  the  newborn.  Part  of 
another  reads: 

“The  voice  of  the  Re  calls  for  the  Wpt,  because  the  stomach  of  this  infant 
whom  Isis  has  borne,  is  sick.”* 

The  Papyrus  Ebers  (1550  B.C.),  a beautiful  document  in  hieratic 
script,  the  text  in  black,  the  rubrics  in  red,  is  an  edition  de  luxe,  prob- 
ably prepared  for  some  great  temple.  The  fact  that  it  is  written  in 
several  dialects  indicates  that  it  is  an  encyclopedia  or  compilation. 
In  its  entirety,  it  was,  no  doubt,  a summary  of  the  medical  and  surgical 
therapeutics  then  known,  like  the  summations  ( summa  medicines) 
made  in  the  Middle  Ages  or  our  modern  “Systems  of  Medicine.” 
It  consists  of  some  50  sections  in  108  columns,  giving  prescriptions  for 
various  diseases  and  classes  of  diseases.  Only  in  the  surgical  section 
is  there  any  indication  of  diagnosis.  The  tiny  pediatric  section  is 
mainly  prognostic.  It  reads: 

“To  get  a supply  of  milk  in  a woman’s  breast  for  suckling  a child:  Warm  the 
bones  of  a xra-fish  (swordfish,  Brugsch)  in  oil  and  rub  her  back  with  it.  Or: 

Let  the  woman  sit  cross-legged  and  eat  fragrant  bread  of  soured  durra,  while 
rubbing  the  parts  with  the  poppy  plant.” 

Prognosis  for  a child  on  the  day  of  its  birth: 

If  it  cries  nee,  it  will  live;  if  it  cries  ba  it  will  die. 

Another  prognostication : 

If  it  wails  loudly,  it  will  die;  if  it  drops  its  face  downward,  it  will  die  imme- 
diately.”! 

Among  the  diseases  likely  to  affect  children,  which  are  prescribed 
for  in  the  Ebers  Papyrus,  we  find  those  due  to  the  heft- worm.  ( Ascaris 
lumbricoides),  the  pend-worm  (Tceriia  mediocanellata) , diseases  of  the 

* Bayard  Holmes  and  P.  G.  Kitterman,  “Medicine  in  Ancient  Egypt.”  Cin- 
cinnati (1914),  p.  13. 

f H.  Joachim,  “Papyros  Ebers.”  Berlin  (1890),  pp.  178-179. 


14 


HISTORY  OF  PEDIATRICS 


Ro-ab  (epigastric  region),  headache;  ascites  and  urinary  disorders; 
physical  disability;  diseases  of  the  eye,  the  scalp,  the  skin,  the  teeth 
and  ears;  coryza  and  ozaena;  animal  parasites,  fleas,  lice  and  pruritus; 
abscesses  and  tumors.  Purgatives  and  vermifuges  abound,  as  also 
prescriptions  for  diarrhoea  and  obstinate  vomiting.  The  following 
recipes  are  specified  for  retention  of  urine  in  children: 

“An  old  book,  cooked  in  oil.  is  smeared  over  the  body,  in  order  to  produce 
urination  in  the  child.” 

“Another  prescription  to  regulate  urination: 

Straw  of  the  nebat  plant 

Dates  

The  stalk  of  the  xas-it  plant  

Honey  

Berries  of  the  uan-tree  

Water 

Strain  and  administer  through  four  days  running.” 

“Another  prescription  to  regulate  urination  in  a child:  Bring  blossoms  of  the 
nebat  plant  together  with  sweet  beet  in  a cool  flask  for  a girl  to  drink;  but  give  it  to 
a boy  in  a pitcher  of  hennu  (0.465  litre)  capacity.” 

“What  one  should  do  for  a child  that  suffers  from  urination:  xent  corn  warmed 
in  a pill;  if  it  is  an  older  child  let  it  take  this  with  its  nourishment;  but  if  it  is  an 
infant,  let  it  be  given  in  the  breast  milk,  the  nurse  warming  it  in  her  mouth  and 
spurting  it  into  the  child’s  mouth.” 

“A  remedy  for  incontinence  of  urine. 

Juniper  berries 1 

Cyprus 1 

Beer 1 hennu  measure.”* 

An  opiate  is  exhibited  for  the  crying  of  a child. 

“Capsules  of  the  poppy-plant  (?);  excrement  of  wasps  on  the  wall;  rub  together; 
strain  and  administer  for  four  days  running;  it  will  stop  immediately;  as  for  crying, 
it  is  the  child  that  cries.”  f 

These  prescriptions  show  that  there  was  already  differentiation  as 
to  drugging  and  dosage  in  treating  the  diseases  of  children  and  adults. 
There  were  even  separate  hieroglyphs  for  the  infant  and  the  child 
(Luring). 

Among  the  diseases  from  intestinal  worms,  there  are  many  remedies 
for  the  tropical  anemia  variously  known  in  the  Ebers  Papyrus  as  the 
uha  disease  (chronic  constipation  and  meteorism),  the  uxedu  disease 
(painful  swelling  of  the  body),  and  “the  god-sent  deadly  aaa  disease.-’ 
It  is  probable  that  these  were  different  phases  of  hookworm  infection 
(chlorosis  Aegyptica ) or  other  parasitic  anemias.  In  the  opinion  of 
Joachim,  the  aaa  disease  was  ankylostomiasis,  since  precordial  distress 
and  palpitation  of  the  heart  is  specified  in  the  Papyrus  (Lutz),  and  the 
disease  was  found  by  Pruner  Bey,  Bilharz  and  Griesinger,  to  be  still 
prevalent  in  Egypt.  + Edwin  Pfister,  however,  maintains  that  the  aaa 
disease  was  bilharziosis,  since  its  determinative  hieroglyph  was  a 

* Joachim:  op.  tit.,  65,  67-68. 
f Ibid;  p.  169. 
t Ibid.,  pp.  xiv-xvii. 


■ H 

■ 14 
• % 

• 14 

. 1 dend 


EGYPT 


15 


phallus  (bloody  urine).* * * §  There  is  a special  prescription  for  the 
sa-worm  or  Filaria  medinensis.\  Granular  conjunctivitis  (Egyptian 
ophthalmia),  the  contagious  nature  of  which  was  first  observed  by 
Baron  Larrey  during  Napoleon’s  Egyptian  campaign  (1802),  is 
specified  in  the  Ebers  Papyrus  as  excessive  lachrymation  or  “granula- 
tion” or  “when  too  much  water  flows  from  the  eye.”l  Corneal 
opacity,  albugo,  clouding  of  the  lens  and  strabismus  are  prescribed 
for,§  and  there  are  innumerable  salves  and  collyria.  The  sections  in 
the  Ebers  Papyrus  on  fatty  tumors,  suppuration  and  ulcers  show  defi- 
nitely that  surgical  intervention  obtained  in  these  conditions  (“treat  it 
with  the  knife”). ||  Toothache  is  attributed  to  the  presence  of  the 
uxedu  worm. if  The  researches  of  Elliot  Smith  and  Wood  Jones  on 
pathological  findings  in  Egyptian  mummies  from  the  Archseological 
Survey  of  Nubia  (1907),  show  that  there  was  no  caries  in  the  milk 
dentition  of  children  of  the  Pre-Dvnastic  period.  The  luxurious  habits 
of  the  New  Empire  produced  deposits  of  tartar  with  caries  and  abscess 
formation,  spreading  to  the  alveoli.  This  condition  in  the  mummies 
shows  that  the  Egyptians  had  no  dentistry,  the  alleged  gold-filling 
of  teeth  being  simply  gilding,  as  part  of  the  mortuary  ritual.  There 
is  one  disease,  specified  in  the  Papyrus  Ebers  as  “hardening  in  the 
limbs”  (and  by  the  prescriptions  “to  make  the  joints  limber”),** * * §§  which 
is  found  in  mummies  of  all  historic  periods,  namely  osteoarthritis 
deformans,  and  while  this  affected  adults  only,  it  began  to  attack  them 
even  in  the  third  decade  of  life.  An  apparent  case  of  infantile  paralysis 
(poliomyelitis)  is  exhibited  in  a stele  of  the  Eighteenth  Dynasty  in  the 
Carlsberg  Glyptothek,  Copenhagen,  f | Henri  Meige  describes  a bronze 
statuette  of  a hump-backed  Egyptian  boy  from  the  Museum  at  Bulaq, 
the  deformities  suggesting  rickets  or  spondylitis  deformans,  tt  The 
innumerable  figurines  of  the  dwarf-gods  Bes  and  Phthah  are  all 
achondroplasic  (Charcot). §§  In  the  Alexandrian  period,  Egyptian 
medicine  became  Greek  in  type.  In  Sudhoff’s  study  of  the  Oxyrhyn- 
chus  and  other  Greek  papyri  of  the  period,  considerable  light  is  thrown 
upon  the  methods  of  wet-nursing  and  circumcision.  The  Hellenized 
ladies  of  the  Ptolemaic  period  seldom  nursed  their  own  children. 
Definite  contracts  were  made  with  slave-women,  who  stipulated  to 
nourish  the  child  on  milk  up  to  its  third  year  (yaXaKTor pocfna)  for  a 
definite  sum  and  their  living.  During  the  first  six  months  the  nurse 
was  to  give  the  infant  her  own  breast;  during  the  remaining  eighteen 
months,  it  was  nourished  artificially  on  cow’s  milk.  There  was  a 

* Pfister,  Arch.  f.  Gesch.  d.  Med.,  Leipzig,  1912-13,  vi,  12-20. 

t Joachim:  op.  cit.,  p.  134. 

j Ibid.,  pp.  81,  83;  86. 

§ Ibid.,  pp.  82;  85-87. 

||  Joachim:  op.  cit.,  pp.  191-192. 

If  Ibid.,  p.  161. 

**  Ibid.,  pp.  130-134;  137-151. 

ft  O.  Hamburger:  Bull.  Soc.  franc,  d'hist.  de  m6d.,  Paris,  1911,  x,  pp.  407-412. 

tt  Meige:  Trav4  de  neurol.  chir.  (Chipault),  Paris,  1897,  ii,  pp.  101-105. 

§§  Charcot:  “Les  difformes  et  les  malades  dans  Part.”  Paris  (1889),  pp.  12-26. 


16 


HISTORY  OF  PEDIATRICS 


regular  daily  delivery  of  “the  best  cow’s  milk  ” in  a pitcher  of  18  cotyles 
capacity;  and  unpunctual  delivery  was  severely  punished,  but  on  legal, 


Fig.  1. — Egyptian  nursing-flask  of 
the  Alexandrian  period,  with  nipple 
(Cairo  Museum).  (From  Sudhoif’s 
Studien  zur  Geschichte  der  Medizin, 
Leipzig,  1909,  Heft.  5-6,  PI.  III.) 


not  on  hygienic  grounds.* * * §  The 
wet-nursing  contracts  called  for 
“pure  unadulterated  milk,”  i.e., 
that  the  nurse  should  not  spoil 
her  breast-milk  by  a faulty 
diet.  A child’s  sucking  bottle 
of  the  2nd  century,  from  Teb- 
tunis,  is  in  the  Museum  of  Cairo 
(reproduced  by  Sudhoff).  It  is 
an  ovoid  flask  of  polished  burnt 
clay,  with  a cylindrical  neck  and 
a nipple-shaped  mouth-piece  at 
the  side.f  The  slaves  who 
became  gladiators,  wet-nurses, 
harlots,  etc.,  w7ere  recruited 
from  the  abandoned  infants 
flung  upon  dung-heaps  by 
heartless  parents.  If  found  by 
benevolent  persons,  they  were 
usually  wet-nursed  and  brought 
up.  If  not  they  were  devoured 
by  dogs  and  wflld  animals. 
Baby  farming  was  practiced, 
and  attended  by  the  same 
cruelties  that  moderns  know  of.+ 


SUMER  AND  ACCAD 

(Assyro -Babylonian  Civilization  [2800  B.C.-33J0  B.C.]) 

The  fertile  plain  between  the  Euphrates  and  the  Tigris,  “the  land 
between  the  rivers,”  erstwhile  Babylonia,  later  Mesopotamia,  was 
originally  divided  between  two  primeval  races.  At  the  North  was 
Accad,  dominated  by  a Semitic  race;  at  the  South  lay  the  Biblical 
“plain  of  Shinar”  or  Sumer,  the  inhabitants  of  which  were  non-Semitic. 
Whether  the  Sumerian  culture  preceded  the  Accadian  or  not  is  a 
matter  of  dispute,  but  it  is  known  that  the  Sumerian  characters 
(ideograms)  contained  Semitic  elements,  and  it  is  probable  that  there 
was  the  usual  interaction  between  the  two  cultures. 

Secular  History. § — The  tug  of  war  between  the  Sumerian  and  Accadian 
peoples  occupied  the  earlier  historical  period,  a period  of  massive  architecture, 

* K.  Sudhoff : Aerztliches  aus  griechischen  Papyrus-Urkunden  (Stud.  z. 
Gesch.  d.  Med.,  Heft  5-6).”  Leipzig  1909,  pp.  150-157. 

t Ibid.,  plate  3. 

t Ibid.,  pp  1.  58-159. 

§ M.  Jastrpw:  “Aspects  of  Religious  Belief  and  Practice  in  Babylonia  and 
Assyria.”  New  York,  1911. 


SUMER  AND  ACCAD 


17 


sun  and  moon  gods,  ornamented  vases  and  other  votive  offerings  to  such  gods,  and 
illustrated  clay  seal  cylinders  with  cuneiform  characters,  designed  to  be  rolled 
over  flat  clay  tablets  as  personal  signatures  to  contracts  and  other  business  docu- 
ments. Under  Sargon  and  his  son  Naram-Sin,  the  Accadians  first  began  to  domi- 
nate this  vast  agricultural  region;  but  about  2300  B.C.,  the  Sumerians  regained 
their  ancient  sway  and  their  rulers  were  thenceforth  known  as  “kings  of  Sumer  and 
Accad.”  At  the  North  of  Accad,  Hittite  influences  became  predominant  about 
2100  B.C.  A Hittite  ruler  occupied  the  throne  of  Babylon  (Accadia)  about  1800 
B.C.,  and  from  a presumable  fusion  of  Hittite  and  Amorite  elements,  the  northern- 
most kingdom  of  Assyria  arose.  About  2000  B.C.,  the  Sumerian  power  began  to 
wane  and  the  Semites  centred  their  independent  kingdom  in  the  city  of  Babjdon. 
With  the  accession  of  Hammurabi  as  “king  of  Babylon”  (1958-1916  B.C.),  the  Acca- 
dian  kingdom  became  known  as  the  Babylonian  Empire.  The  successive  blows 
dealt  by  the  warlike  Assyrian  kings  Tiglath  Pileser  I ( circa  1130-1100  B.C.), 
Ashurnasirpal  (884-860  B.C.),  Sennacherib  (705-681  B.C.)  and  Esarhaddon 
(680-669  B.C.)  eventually  reduced  Babylon  to  subjection.  Babylon  was  destroyed 
by  Sennacherib  in  689  B.C.,  but  after  the  brilliant  reign  of  Ashurbanipal  or  Sar- 
danapalus  (668-626  B.C.),  the  Assyrian  yoke  was  broken  by  Northern  invaders 
at  the  fall  of  Nineveh  (606  B.C.).  The  new  Babylonian  empire  came  under 
Chaldean  influences  under  Nabopolassar  (625-604  B.C.)  and  his,  son  Nebuch- 
adnezzar (604-561  B.C.)  Cyrus  took  Babylon  in  539  B.C.  but  the  Persian  power 
was  overthrown  by  Alexander  the  Great  (331  B.C.).  Thus  the  civilization  called 
Assyro-Babylonian  was  influenced  successively  by  the  domination  of  five  distinct 
racial  and  cultural  strains,  the  Sumerian,  Accadian  (Semitic),  Assyrian  (Hittite), 
Chaldean  and  Persian. 

In  the  older  Sumerian  pantheon,  the  sun,  the  moon,  fertility  in 
plants,  animals  and  man,  storm-power  and  water-power  were  deified 
and  worshipped  in  various  places  as  gods.  In  the  period  of  Babylonian 
ascendancy,  the  storm-gods  Enlil  and  Ninib  give  place  to  two  new 
deities,  Marduk,  the  sun-  and  water-god,  the  source  of  wisdom,  and 
Nergal,  representing  the  sun’s  destructive  power,  the  god  of  pestilence, 
famine,  war  and  death.  Ninib  was  the  ancient  god  of  healing,  and 
with  him  was  always  associated  his  consort  Gula.* 

But  in  the  period  of  Assyrian  domination,  the  mother-goddess 
Ishtar,  as  the  consort  of  Ashur,  a great  god  of  the  Assyrian  pantheon, 
becomes  the  central  figure  of  the  Assyro-Babylonian  culture.  The 
ascendancy  of  Ishtar  as  mother-goddess  is  an  index  of  the  strong 
matriarchal  element  which  prevailed  in  the  Assyro-Babylonian  period, 
an  influence  which,  as  Morris  Jastrow  points  out,  is  characteristic 
of  all  ancient  Semitic  civilizations.  Ishtar,  identical  with  the  planet 
Venus  in  Babylonian  astrology,  the  Ashtoreth  of  the  Canaanites, 
the  Astarte  of  the  Phoenicians,  may  be  equated  with  Rhea  and  Hathor, 
the  mother-goddesses  of  Crete  and  Egypt,  or  with  the  alma  genetrix 
of  Rome.  Ishtar  represents  the  generative  principle  in  nature, 
“the  mater  magna  who  gives  birth  to  everything  that  has  life.”  She 
presides  over  fertility  in  vegetation,  animals,  and  man,  is  simulta- 
neously the  goddess  of  love,  of  war  and  storms,  the  protectress  of 
flocks  and  the  universal  nurse  of  mankind.  In  the  votive  figurines 
which  have  been  found,  she  is  represented  as  a nude  figure  of  comely 
aspect,  usually  suckling  a child  supported  on  her  left  arm. 

* For  a full  account  of  the  Babylonian  mythology,  see  M.  Jastrow:  “Aspects 
of  Religious  Belief  and  Practice  in  Babylonia  and  Assyria,”  New  York  (1911). 

Vol.  I — 2 


18 


HISTORY  OF  PEDIATRICS 


In  a civilization  with  undoubted  matriarchal  tendencies,  there  is  a 
strong  presumption  that  children  will  be  not  unkindly  treated.  Baby- 
lonian alabaster  dolls  exist,  and  are  remarkable  for  beauty.  From 


Fig.  2. — Terra-cotta  reliefs  and  figurines  of  Ishtar  (Babylonian  mother-goddess). 


the  items  listed  in  the  Assyro-Babylonian  group  in  Sudhoff’s  Catalogue 
of  the  Dresden  Hygienic  Exhibit  (Historical  Section),  we  get  some  idea 
of  the  degree  of  civilization  of  these  remarkable  peoples. 

Reliefs  and  bronzes  show  King  Ashurbanipal  and  his  queen  dining  in  the  open 
under  a grape-arbor  (621);  the  interior  of  a Babylonian  tent,  in  which  beds  are 
made,  flies  are  driven  away,  and  tables  with  low  seats  are  set  for  dining  (621); 
King  Ashurbanipal  under  a parasol  held  by  eunuchs  (731);  Sennacherib  under  a 
parasol  in  a deer-park,  with  a coach  drawn  by  men  (732);  boxing  to  the  accom- 
paniment of  drums  and  castanets  (742);  riding  and  hunting  scenes  (742-3); 
swimming  with  bladders  (745-6);  the  transportation  of  a huge  stone  colossus  in  a 
vehicle  drawn  by  men  (758);  business  archives  and  contracts  in  cuneiform  char- 
acters on  clay  tablets  (788-803),  and  the  slipper-shaped  coffins,  capsule  tombs  and 
fan -shaped  sarcophagi  for  disposal  of  the  dead  (807-845).  Among  the  medical 
and  pediatric  items  are  the  duties  of  a nurse,  from  the  Code  Hammurabi  (611 ); 
the  remarkable  Babylonian  wells,  drainage  pipes  and  latrines  (636-648);  pre- 
scriptions for  cult-cleanliness  (650);  rites  for  the  purification  of  a city  contami- 
nated by  excreta  of  sick  people  (650);  children’s  clothing  in  the  time  of  Ashur- 
banipal, from  a relief  at  Nineveh  (675);  a woman  suckling  her  child,  from  a Hittite 
relief  (705);  fly-flaps  (716-18);  laws  against  the  injury  of  pregnant  women  (736); 
physicians’  seals  (762-3);  cuneiform  prescriptions  for  a skin  disease  (765);  models 
of  the  liver  (766-7);  amulets  (779-80);  vultures  as  scavengers  of  the  battle-field, 
with  collection  of  the  fallen  dead  in  a common  pit  (806),  and  children’s  coffins 
(816-17).* 

In  the  Code  of  Hammurabi  (2250  B.C.)  we  find  the  strongest 
evidence  of  equitable  dealing  with  women  and  children  in  Babylon. 
The  Code-Hammurabi  is  perhaps  the  oldest  codification  of  laws  known. 
In  simplicity  and  directness  of  statement  it  is  a model  of  what  a law- 
book should  be.  There  is  no  pettifogging  or  obscuration;  everything 
is  expressed  with  such  unmistakable  clearness  that  it  could  be  understood 
even  by  the  unlettered  and  ignorant.  There  are  some  harsh  rigors  and 

*Sudhoff:  Dresden  Catalogue  (1911),  pp.  20-28. 


SUMER  AND  ACCAD 


19 


the  lex  talionis  (“an  eye  for  an  eye,  a tooth  for  a tooth”)  is  prominent, 
but  with  inexerable  fairness. 

Adultery,  seduction,  rape  and  incest  were  punishable  by  death.  The  loss  of 
any  part  of  the  body  in  an  assault  was  punished  by  the  loss  of  the  same  part  in  the 
offender.  If  a son  denied  his  parents,  his  tongue  was  excised  (192);  if  he  hated 
them,  he  lost  an  eye  (193);  if  he  struck  his  father,  his  fingers  were  cut  off  (195); 
if  a nurse  allowed  a suckling  to  die  on  her  hands  and  substituted  another,  her 
breast  was  amputated  (194);  if  a man  struck  a pregnant  woman  producing  mis- 
carriage, he  had  to  pay  the  expenses  to  ten  silver  shekels  (209);  if  she  died,  the 
offender’s  daughter  was  put  to  death  (210).  A man  in  debt  might  sell  his  wife, 
son  or  daughter  or  bind  them  out  for  service  for  three  years,  after  which  they  were 
free  (117).  If  a man  put  away  a wife  or  concubine,  he  must  make  good  her 
dowry;  if  she  had  children,  their  support  was  assured  (137-8).  If  a wife  died, 
her  dowry  went  to  her  children  (162);  if  she  had  a successor,  the  children  of  the  two 
marriages  inherited  the  dowries  of  their  respective  mothers  and  an  equal  share  of 
their  father’s  effects  (167).  Property  deeded  to  a widow  by  her  husband  could 
not  be  sold  but  went  to  her  children  after  her  death  (171).  The  children  of  a 
slave  (father  or  mother)  were  free,  if  the  other  parent  was  free  (171,  175).  If  a 
woman  married  twice,  she  inherited  a son’s  full  share  of  his  estate  (180).  An 
adopted  child  could  not  be  claimed  by  anyone  (185).  If  an  adopted  son  were  not 
fairly  treated,  he  might  return  to  his  father’s  house  (189-190);  an  adopted  child 
could  not  be  disinherited  by  its  foster  parent,  unless  he  received  one  third  of  a son’s 
portion  in  advance  (191).* 

Thus  the  attitude  of  Babylon  toward  women  and  children  was 
that  of  a nation  of  lawgivers.  They  were  severely  punished  for 
infractions  of  the  Code,  but  otherwise  treated  with  absolute,  unswerv- 
ing justice.  Long  before  Hammurabi,  King  Urukagina  did  much  for 
the  maintenance  of  the  family  by  abolishing  the  briberies  connected 
with  the  divorce  laws.  Mothers  were  pensioned  that  their  children 
might  be  educated.  Women  could  hold  property  and  maintain 
their  property  rights.  The  signature  of  the  queen  was  added  to 
that  of  the  king  in  all  public  documents.  In  a statistical  table  of  the 
time  giving  the  provisions  made  for  women  attached  to  the  temple  of 
Bau,  552  women,  132  girls  and  97  boys  are  enumerated.  The  pre- 
ponderance of  the  female  element  shows  that  there  was  no  prejudice 
against  girls  nor  any  female  infanticide.  The  Sumerian  family  seldom 
included  more  than  four  infants.  The  Assyrian  Doomsday  Book 
(Liber  Censualis)  of  the  7th  Century  B.C.  enumerates  68  husbands 
with  94  wives,  74  sons  and  26  daughters,  but  in  some  of  the  families, 
there  were  three  daughters  to  one  son.  Most  of  the  families  were 
limited  to  one  or  two  sons,  which  suggests  birth  control,  but  not  female 
infanticide.f  The  modesty  of  Babylonian  art  has  been  noted  by  Ward. 
In  the  items  of  female  costume  listed  by  Sudhoff  in  his  Dresden  Cata- 
logue (652-705),  there  is  no  evidence  of  deliberate  exposure  of  the 
breasts,  as  in  Egypt,  primordial  Crete  or  even  Hellas.  Women  were 
well  covered  by  the  Sumerian  mantles  and  Semitic  plaids,  which  were 
wrapped  about  the  body  in  terrace-fashion.  The  comeliness  of  the 
Babylonian  female  figurines  and  dolls  suggests  the  kind  of  lively 
appreciation  which  leads  women  to  conserve  their  beauty. 

* R.  F.  Harper:  “The  Code  of  Hammurabi,”  Chicago  (1904),  passim. 

f G.  K.  Payne:  “The  Child,”  New  York  (1916),  pp.  95-105. 


20 


HISTORY  OF  PEDIATRICS 


Herodotus  describes  the  Babylonians  as  having  no  physicians,  the 
sick  being  placed  in  the  market  place  to  receive  the  advice  of  every 
passer-by.  But  the  rigorous  regulation  of  medical  fees  in  the  Code 
Hammurabi  suggests  an  advanced  stage  of  specialization  in  medical 
practice,  even  in  remote  antiquity  (2250  B.C.).  The  essential  fea- 
tures of  Babylonian  medicine  were  the  attribution  of  each  disease 
to  a special  demon;  diagnosis  by  inspection;  prognosis  by  divina- 
tion, liver-inspection  (hepatoscopy),  birth  omens,  disease  omens 
and  astrological  portents;  therapy  by  exorcision  and  exhibition  of 
herbal  remedies;  prophylaxis  by  incantation  (Jastrow).*  In  the 
Sudhoff  Catalogue,  there  are  listed  bronze  figurations  of  TJtukku,  the 
demon  of  the  throat  disease,  possibly  diphtheria  (775a),  and  exorcisms 
against  Labartu,  the  demon  who  threatens  the  lying-in  woman  and  her 
new-born  child  (776-783).  In  a bronze  tablet,  described  by  Morris 
Jastrow,  there  are  seven  demons  of  disease,  terrible  in  aspect,  and 
Labartu  appears  as  a horrible  figure  “holding  a serpent  in  each  hand, 
with  swine  sucking  at  her  breasts.”  Exorcisers,  clad  in  the  robes  of 
the  god  Ea,  stand  at  either  end  of  the  sick  bed,  sprinkling  the  patient 
with  some  compound  to  drive  the  particular  demon  away.f  The  terra 
cotta  models  of  sheeps’  livers  for  divination,  some  of  them  3,000 
years  old,  divided  off  into  squares,  with  prophetic  inscriptions,  are 
better  examples  of  anatomical  illustration  than  the  five-lobed  fivers 
of  the  medieval  anatomists.  The  fiver  was  the  source  of  blood  and  the 
seat  of  the  soul,  and  to  see  into  the  soul  gave  insight  into  the  mind  of 
the  god,  when  enterprises  of  moment  were  contemplated. 

The  Babylonian  birth  omens,  of  which  the  study  of  physiognomy 
and  phrenology  were  by-products  (Jastrow),  were  connected  with  the 
primitive  awe  for  “the  mysterious  phenomenon  of  a new  fife  issuing 
from  another.”  Babylonian  pediatrics  was,  in  fact,  mainly  con- 
cerned with  this  variety  of  prognostication.  Any  abnormity  or  mon- 
strosity in  an  infant  or  an  animal  at  birth  was  prognostic  of  its  future 
welfare.  “An  abnormally  large  organ  pointed  to  extension,  to  power, 
to  success;  an  abnormally  small  one  to' weakness,  disease  and  failure” 
(Jastrow).  This  is  in  agreement  with  Adler’s  psychological  theory 
of  “organ  inferiority”  as  a cause  of  mental  depression  and  discourage- 
ment. Abnormality  or  hypertrophy  on  the  right  side  concerned  the 
patient,  on  the  left  side  his  enemy.  The  Babylonian  birth  omens 
have  been  studied  by  Boissier  (1894),  Jastrow  (1913)  and  Dennefeld 
(1914).  A few  specimens,  from  Jastrow’s  study  are  subjoined: 

“If  a woman  gives  birth  to  twins  in  an  abnormal  condition,  the  land  will 
perish,  the  house  of  the  man  will  be  destroyed. 

“If  a woman  gives  birth  to  two  girls,  the  house  will  be  destroyed. 

“If  a woman  gives  birth  and  the  right  ear  is  small,  the  house  of  the  man  will  be 
destroyed;  if  the  left  ear  is  small,  the  house  of  the  man  will  be  enlarged;  if  both  ears 
are  small,  the  house  of  the  man  will  be  overthrown. 

“If  a woman  gives  birth  and  there  are  six  toes  on  the  right  and  on  the  left  foot, 
the  children  will  encounter  misfortune. 

* M.  Jastrow,  Proc.'  Roy.  Soc.  Med.,  Lond.,  vii  (1914),  pp.  109-176,  passim. 

f Ibid.,  p.  137. 


SUMER  AND  ACCAD 


21 


“If  a woman  gites  birth  and  the  child  has  a lion’s  ear,  a powerful  king  will 
rule  the  land. 

“If  a woman  gives  birth  and  the  upper  lip  rides  over  the  lower  one  (agnathy), 
he  will  attain  favor.”* 

While  these  omens,  as  in  the  savage,  suggest  a motive  for  infanti- 
cide, yet  it  seems  probable,  given  the  Babylonian’s  regard  for  the 
inexorable  and  irrevocable  in  law  and  accomplished  fact,  that  infanti- 
cide in  itself  was  not  regarded  as  releasing  the  land  or  the  individual 
from  the  ineluctable  fate  contained  in  the  specific  omen. 

There  were  also  omens  of  the  same  kind  connected  with  the  inter- 
pretation of  peculiarities  in  disease,  or  the  symptoms  of  disease. 

In  the  treatment  of  disease,  a pain  in  a definite  locality  implied 
that  a demon  was  eating  that  locality;  a symptom  like  fever  or  head- 
ache implied  that  the  part  affected  was  “seized”  by  the  demon.  In 
the  Middle  Ages,  this  Babylonian  concept  of  seizure  or  possession 
by  demons  ( sibtu ) was  still  applied  to>  epilepsy  ( bennu ).  Epilepsy 
was  then  regarded  as  contagious  and  there  were  actual  isolation 
hospitals  for  epileptics  in  the  medieval  period  (Sudhoff).  Babylonian 
therapy  was  of  two  kinds,  that  in  which  exorcism  and  incantations  were 
secondar}r  to  the  exhibition  of  remedies,  and  that  in  which  the  use  of 
drugs  was  subordinated  to  magic  rites  (Jastrow).  Over  three  hundred 
drugs  were  known  and  divided,  Jastrow  believes,  into  organic  ( shammu ) 
and  inorganic  ( abnu ).  Thus  a cold  in  the  stomach  (gastritis)  was 
treated  by  drinking  a decoction  of  licorice  and  six  other  drug  simples 
in  wine,  night  and  morning;  the  patient  was  then  taken  into  a boat  and 
incantations  were  pronounced  over  him.  As  alternatives,  the  white 
meat  of  pork  was  sucked,  to  coax  the  demon  out,  salt  and  water 
were  taken  with  the  food,  a kneeling  posture,  to  relax  the  muscles  of 
the  abdomen,  was  assumed,  hot  or  cold  water  was  poured  over  the 
body,  to  stimulate  the  circulation,  and  even  postures  and  rolling  were 
employed,  f Nauseating  remedies  were  sometimes  given  to  disgust 
the  demon.  Dietetic  schemes  were  followed  in  digestive  disorders. 
Massage  was  known  and  employed.  The  principal  diseases  known 
were  those  of  the  liver  or  gall-bladder  (jaundice),  the  eye,  the  heart, 
the  stomach,  also  rheumatism,  neuralgia,  and  the  mangu  disease, 
which  was  probably  diphtheria. 

Strongly  suggestive  of  the  Consilia  of  the  Middle  Ages  are  the 
following  letters  (cited  by  Jastrow)  from  the  physician  Arad-Nanato 
the  King  Assurbanipal  on  certain  ailments  of  his  little  son.  j In  each, 
Ninib,  the  god  of  healing  and  his  consort  Gula  are  invoked. 

“Arad  Nana  to  the  king  My  Lord,  Thy  servant  Arad  Nana.  Hearty  greetings 
to  the  king,  My  Lord.  May  Ninib  and  Gula  grant  happiness  and  health  to  the 
king  My  Lord. 

Hearty  greetings  to  the  little  chap  whose  eye  causes  him  trouble.  I put  a 

* M.  Jastrow:  “ Babylonian-Assyrian  Birth  Omens  and  Their  Cultural  Sig- 
nificance,” Giessen  (1914),  passim. 

f Jastrow,  Proc.  Roy.  Soc.  Med.  Sect.  Hist.  Med.,  Lond.,  vii  (1914),  pp. 
131-133. 

t Ibid.,  pp.  147-149. 


22 


HISTORY  OF  PEDIATRICS 


bandage  on  his  face.  Yesterday,  towards  evening,  I took  off  the  bandage  that 
had  been  applied,  removing  also  the  dressing  below,  and  there  was  blood  in  the 
dressing  as  much  as  the  point  of  a little  finger.  To  whichever  one  of  thy  gods  this 
is  due,  his  command  has  surely  been  heeded. 

Hearty  greetings.  Let  the  king  My  Lord  rest  assured;  in  seven  or  eight  days 
he  will  be  well.” 

The  second  deals  with  epistaxis: 

“Hearty  greetings  to  the  king’s  son.  The  treatment  which  we  prescribe  for 
him  is  to  be  given  every  two-thirds  of  a double  hour  during  the  day. 

In  regard  to  the  bleeding  of  his  nose  about  which  the  Rab-Mugi  has  reported 
to  me  that  yesterday  toward  evening  there  was  much  bleeding,  those  dressings  are 
not  properly  applied;  they  have  been  placed  upon  the  alae  of  the  nose,  obstructing 
the  breathing,  while  at  the  same  time  the  blood  flows  into  the  mouth.  Let  the 
nose  be  plugged  up  to  the  back  so  that  air  will  be  held  off  and  the  bleeding  will 
cease.  If  it  please  the  king  I will  come  to  look  at  it  tomorrow.  Meanwhile,  may 
I hear  good  news.” 

It  is  plain  that  royal  physicians  in  the  reign  of  Sardanapalus  (668-626 
B.C.)  were  what  they  are  today. 

In  preventive  medicine,  the  Babylonians  had  an  eye  to  the  harm- 
ful effects  of  insects,  worms  and  parasites.  They  made  long  lists 
of  them  on  clay  tablets  (Sudhoff,  item  804),  and  even  classified  them. 
A cylinder  seal  in  Pierpont  Morgan’s  collection  bears  the  “Fly- 
Symbol”  of  Nergal,  the  Mesopotamian  god  of  disease  and  death. 
“Swatting  the  fly”  appears  to  have  been  a Babylonian  institution. 
Sudhoff’s  Catalogue  includes  a fly-flap  as  part  of  the  trousseau  of 
a Mitanni  princess  (716);  a Hittite  relief  of  a servant  by  the  dinner- 
table  with  a fly-fan  (718),  and  a Persian  relief  of  a fly-flap  of  the 
time  of  King  Darius  (730).  That  children  of  the  better  class  were 
similarly  protected  there  can  be  little  doubt. 

The  medicine  of  ancient  Persia  was  limited  to  casting  out  the 
demons  of  disease,  herbal  therapy  and  the  Zoroastrian  rites  of  purifi- 
cation and  cult-cleanliness.  In  such  a system,  pediatrics  never  even 
attained  the  gerundive  mood  of  being  about  to  be. 


INDIA 

In  ancient  India,  as  we  have  seen,  the  'warrior-gentleman  pre- 
dominated, the  caste  system  was  rigid,  the  status  of  women  was  low, 
abortion  and  infanticide  were  common. 

In  the  earliest  Sanskrit  texts,  medicine  is  entirely  theurgic,  made 
up  of  spells  and  incantations  against  the  demons  of  disease.  The 
Rig  Veda  (1500  B.C.)  is  the  folk  hymnal  of  the  Aryans  of  Northwestern 
India  at  the  time  of  their  successive  westward  migrations.  In  this 
great  folk-song,  women  enjoy  an  elevated  position  similar  to  that  in  the 
Homeric  poems.  Beautiful  hymns  were  chanted  in  their  praise. 
Husband  and  wife  were  on  a footing  of  equality  as  “rulers  of  the 
household,”  and  there  is  no  evidence  of  the  burning  of  widows.  Beef 
and  beer  from  the  juice  of  the  soma  or  moon-plant  ( Asclepias  acida ) 
were  the  foods  of  these  hardy  nomads.  The  hymns  of  the  ninth  book 


INDIA 


23 


of  the  Rig  Veda,  which  is  taken  up  with  the  deification  of  the  soma  as 
“overlord  of  plants,”  are  called  pavamani  or  “purificational”  because 
they  were  recited  while  the  juice  expressed  from  the  plant  was  clarify- 
ing. That  physicians  were  employed  and  paid  for  their  services  in  the 
time  of  the  Rig  Veda  is  evidenced  by  Neuburger’s  citations  to  the  effect 
that  the  physician  hopes  to  get  by  his  cures  “ horse,  cattle  and  clothes;” 
also,  “The  waggoner  desires  wood,  the  doctor  sickness,  the  priest 
libations.”*  The  tenth  book  of  the  Rig  Veda  contains  a larger  number 
of  verses  dealing  with  superstitious  practices.  About  1,350  of  these 
are  also  found  in  the  Atharva  Veda  Samhita,  which  belongs  to  a much 
later  period,  and  consists  mainly  of  spells  and  incantations.  Many  of 
the  mantras  or  sacred  sayings  of  the  Atharva  Veda  are  medical  in 
character.  This  text  may  therefore  be  taken  as  representative  of  the 
germinal  Vedic  period  (1500-800  B.C.)  when  medicine  and  magic  were 
synonymous. 

Employing  Whitney’s  translationf  a few  pediatric  charms  of  the 
Atharva  Veda  will  suffice  to  illustrate  this  phase  of  our  subject: 

For  Welfare  and  Long  Life  of  an  Infant  (ii,  13) 

1.  “Giving  life-time,  O Agni,  choosing  old  age,  ghee-fronted,  ghee-backed, 
O Agni,  having  drunk  the  sweet  pleasant  ghee  of  the  cow;  do  afterward  defend  this 
boy  as  a father  his  sons. 

4.  Come,  stand  on  the  stone;  let  they  body  become  a stone;  let  all  the  gods 
make  thy  life-time  a hundred  autumns. 

5.  Thee  here,  of  whom  we  take  the  garment  to  be  first  worn,  let  all  the  gods 
favor;  thee  here,  growing  with  food  growth,  let  many  brothers  be  born  after,  as 
one  well  born.” 


Against  Worms  (v,  23) 

2.  “O  Indra,  lord  of  riches,  smite  thou  the  worms  of  this  boy;  smitten  are  all 
niggards  by  thy  formidable  spell. 

3.  What  one  creeps  about  his  eyes,  what  one  creeps  about  his  nostrils,  what  one 
goes  to  the  midst  of  his  teeth — that  worm  we  grind  up. 

5.  The  worms  that  are  white-sided,  that  are  black  with  white  arms,  and  what- 
ever ones  are  of  all  forms — those  worms  we  grind  up. 

6.  Up  in  the  east  the  sun,  seen  of  all,  slayer  of  the  unseen,  slaying  both  those 
seen  and  unseen,  and  slaughtering  all  worms. 

9.  The  three-headed,  the  three-humped,  the  variegated,  the  whitish  worm — 
I crush  the  ribs  of  it;  I hew  at  its  head. 

13.  Both  of  all  worms  and  of  all  she-worms  I split  the  head  with  a stone,  I 
burn  the  mouth  with  fire.” 

For  Birth  of  Sons  (vi,  11) 

2.  “In  the  male,  indeed,  grows  the  seed;  that  is  poured  along  into  the  woman; 
that  verily  is  the  obtainment  of  a son;  that  Prajapati  said. 

3.  Prajapati,  Anumati,  Sinivali  hath  shaped;  may  he  put  elsewhere  woman- 
birth;  but  may  he  put  here  a male.” 

To  Guard  a Pregnant  Woman  from  Demons  (viii,  6) 

9.  “Whoever  makes  this  woman  having  a dead  child,  or  a miscarriage,  him, 
O herb,  do  thou  make  disappear. 

* Neuburger:  “History  of  Medicine.”  Transl.  by  E.  Playfair,  London,  i (1910), 
p.  45. 

f W.  D.  Whitney:  Atharva-Veda  Samhita  (Harvard  Oriental  Series,  vols. 
vii-viii),  Cambridge  (1905),  passim. 


24 


HISTORY  OF  PEDIATRICS 


18.  Whoever  shall  handle  thy  embryo,  or  shall  make  it  born  dead — let  the 
brown  one,  with  formidable  bow,  make  him  pierced  to  the  heart. 

Against  Various  Diseases  (ix,  8) 

1.  “Headache,  head-ailment,  earache,  anemia,  every  head  disease  of  thine,  do 
we  expel  out  of  thee  by  incantation. 

21.  Forth  from  they  feet,  knees,  hips,  buttocks,  spine,  nape,  the  pains  from 
they  head,  the  disease  have  I made  disappear.” 

In  the  Brahministic  period  (800  B.C.-1000  B.C.),  Indian  medicine 
attained  its  height.  Well-trained  physicians,  descended  on  the 
father’s  side  from  Brahmins,  belonged  to  an  exalted  mixed  caste. 
The  center  of  medical  training  was  the  sacred  city  of  Benares,  the 
seat  of  Brahministic  learning.  Aryan  medicine  in  this  period  is 
remarkable  for  the  highest  development  of  surgery  in  antiquity, 
for  a highly  elaborated  vegetable  materia  medica  and  poison-lore, 
including  the  use  of  hyoscyamus  and  Cannabis  indica  as  soporifics  in 
surgery,  and  a definite  recognition  of  such  facts  as  the  symptoms  and 
sweetish  urine  of  diabetes,  the  transmission  of  malarial  fever  by 
mosquito-bites  and  the  relation  between  bubonic  plague  and  rats. 

The  three  basic  texts  of  Brahminical  medicine  are  the  works  of 
Susruta  (2nd  Century  B.C.)  Charaka  (1st  Century  A.D.),  and 
Vagbhata  (7th  Century  A.D.).  It  is  in  Indian  medicine  that  we 
encounter  for  the  first  time  a reasoned,  consistent  body  of  pediatric 
doctrine.  Taking  the  Susruta  Samhita  as  the  most  representative 
scripture,  we  find  a well-defined  section  on  pediatrics  in  the  chapter  on 
pregnancy.*  After  severing  the  umbilical  cord,  the  baby’s  face  is 
sprayed  with  cold  water,  and  it  is  allowed  to  lick  an  electuary  of  honey, 
clarified  butter,  gold-dust  and  the  expressed  juices  of  Brdhmi  leaves 
and  Anantd  from  the  ring-finger  of  the  feeder.  The  body  of  the  infant 
is  then  anointed  and  bathed  with  infusions  of  certain  barks,  or  with 
decoctions  of  certain  leaves  or  drugs,  or  in  water  in  which  red-hot  gold 
or  silver  bars  have  been  immersed,  according  to  the  season  or  the 
physical  condition  of  the  child.  Breast-feeding  is  postponed  until  the 
fourth  day  after  birth.  Prior  to  breast-feeding,  the  necessary  evacua- 
tion of  the  meconium  is  attained  by  the  simple  device  of  giving  a little 
honey,  a procedure  afterward  standardized  bjT  Rufus  and  Soranus  of 
Ephesus;  its  raison  d'etre  was  apparently  that  of  the  “sugar  diarrhea” 
of  Orgler,  Allen,  Talbot  and  other  metabolists.  On  the  first  day,  the 
baby  is  fed  at  morning,  noon  and  evening  with  a child’s  handful  of 
clarified  butter  and  honey  mixed  with  pulverized  Anantd  roots,  sancti- 
fied by  the  recitation  of  mantras.  On  the  second  and  third  days,  the 
diet  is  clarified  butter  prepared  with  the  Lakshand  root.  On  the  fourth 
day,  the  child  is  given  its  own  handful  of  honey  and  clarified  butter  at 
morning  and  noon;  in  the  evening,  the  mother  squeezes  off  a quantity 
of  her  own  milk  and  gives  the  child  her  breast.  The  infant  is  wrapped 
in  silk,  laid  on  a bed  covered  with  a silken  sheet,  and  fanned  with  the 
branches  of  certain  trees.  A thin  pad,  soaked  in  oil,  is  kept  constantly 

* An  English  Translation  of  the  Sushruta  Samhita,  Calcutta,  ii  (1907-16), 
pp.  221-232. 


INDIA 


25 


on  its  head,  and  its  body  is  fumigated  with  the  fumes  of  mustard,  or 
other  drugs,  to  avert  evil  spirits.  The  same  drugs  are  also  tied 
around  its  head,  neck,  hands  and  feet,  for  this  purpose,  and  the  floor 
of  the  lying-in  room  is  strewn  with  pounded  sesamum,  mustard  and 
linseed.  On  the  tenth  day  of  its  life,  the  rites  of  benediction  are 
performed,  and  the  child  is  named.  A wet-nurse,  when  required, 
is  selected  from  the  matrons  of  the  child’s  own  caste.  She  shall  be 
neither  too  young  nor  too  old,  too  thin  or  too  corpulent,  of  sound  health 
and  good  character,  "of  an  affectionate  heart  and  with  all  her  children 
living,”  nowise  addicted  to  gambling,  debauchery,  day-sleeping,  etc. 
The  breasts  should  be  neither  pendulous  nor  contracted,  the  milk 
plentiful  and  of  good  quality.  Upturned  or  unprominent  nipples  may 
deform  the  child’s  mouth;  flabby,  pendulous  breasts  may  suffocate  it. 
At  nursing,  on  an  auspicious  day,  the  child,  its  head  well-wTashed,  is 
laid  on  the  woman’s  lap,  wrapped  in  clean,  untorn  linen,  with  its  face 
to  the  north  while  the  nurse  looks  to  the  east;  a small  quantity  of  milk 
is  pressed  out  of  the  right  breast,  and  before  lactation  the  breast  is 
washed  and  consecrated  by  the  recitation  of  the  following  mantras,  as 
part  of  the  rite: 

“O  thou  beautiful  damsel,  may  the  four  oceans  of  the  earth  contribute  to  the 
secretion  of  milk  in  thy  breasts  for  the  purpose  of  improving  the  bodily  strength 
of  the  child.  O,  thou,  with  a beautiful  face,  may  the  child,  reared  on  your  milk, 
attain  a long  life,  like  the  gods  made  immortal  with  drinks  of  ambrosia.” 

If  a careless  or  inexperienced  wet-nurse  is  employed,  one  who  does  not 
press  out  the  superfluous  milk  before  suckling,  the  child  may  be 
troubled  with  coughing,  suffocation  or  vomiting.  If  there  is  loss 
or  suppression  of  milk  in  the  mother,  from  anger,  grief  or  lack  of 
affection  for  her  child,  her  equanimity  should  be  restored  and  a 
flow  of  milk  brought  on  by  a generous  diet  of  rice,  barley,  wheat, 
wine,  sesamum-paste,  garlic,  fish,  lotus-stalk,  etc.  Breast-milk 
is  tested  by  casting  it  in  water.  Pure  and  healthy  milk  is  thin,  cold, 
clear,  the  color  of  a conch-shell,  easily  miscible  with  water,  neither 
floating  nor  sinking,  and  producing  neither  froths  nor  shreds.  The 
child  should  not  be  permitted  to  suck  from  the  breast  of  a woman 
who  is  hungry,  aggrieved,  tired,  feverish,  pregnant,  who  has  a bad 
digestion,  acid  stomach,  or  is  otherwise  unhealthy;  if  medicine  has  to  be 
administered  to  the  child,  it  should  not  be  suckled  until  the  drug 
is  assimilated. 

In  the  diagnosis  of  infantile  diseases,  it  is  noted  that  the  child 
constantly  touches  the  part  affected  or  cries  at  the  least  touch  of  it. 
If  the  disease  is  in  the  head,  the  child  cannot  raise  it  or  move  it  about, 
and  remains  with  its  eyes  closely  shut.  If  the  bladder  is  affected,  there 
is  retention  of  urine,  thirst,  pain  and  occasional  fainting  spells.  If 
there  is  trouble  in  the  colon,  the  affection  is  indicated  by  retention  of 
urine,  constipation,  discolored  complexion,  vomiting,  distention  of  the 
abdomen  and  gurgling  of  the  intestines  (colonic  impaction  or  Hirsch- 
sprung’s disease).  Constant  crying  indicates  a general  infection  or 
diathesis.  Diseases  of  all  kinds,  which  might  affect  children,  are 


26 


HISTORY  OF  PEDIATRICS 


described  in  other  parts  of  the  Susruta,  in  particular  “spleen  belly” 
(enlargement  and  displacement  of  the  spleen),  “liver-swelling,”  vertigo, 
epilepsy,  hemicrania,  tetanus,  malarial  fever,  cholera,  smallpox, 
intestinal  worms,  skin  and  venereal  affections,  but  as  Neuburger 
observes,  the  innumerable  varieties  of  these  diseases  indicate  that  each 
was  “nothing  but  a vague  symptom-complex,  which,  upon  the  slightest 
deviation  from  its  supposed  type,  dissolved  itself  to  reappear  in  a 
number  of  fresh  categories.”*  As  with  the  Egyptians  and  the  Baby- 
lonians, many  ailments  of  the  eyes,  teeth,  ears,  head,  and  heart  were 
ascribed  to  the  presence  of  “worms”  and  treated  with  charms.  The 
various  remedies  recommended  for  different  diseases  in  the  Susruta 
are  usually  recommended  for  the  same  diseases  in  infants  and  children, 
but  in  doses  of  milder  potency.  In  such  instances,  the  dose  is  ad- 
ministered either  through  the  vehicle  of  milk  and  clarified  butter,  or 
by  the  nurse  who  swallows  the  remedy  herself,  so  that  the  child  may  get 
the  effect  through  the  breast-milk;  or  else  plasters  it  as  a paste  over  her 
breasts.  If  the  child  is  living  on  solid  food,  the  remedy  is  administered 
as  a decoction.  A small  pinchful  of  medicine  may  be  given  to  an  infant 
at  the  end  of  its  first  month  of  life,  if  necessary.  There  are  indications 
of  dosage  to  suit  the  age  of  the  child.  If  the  child  is  fed  on  milk  and 
rice,  medicated  pastes  the  size  of  plum-stones  are  given;  if  it  feeds  oir 
rice  or  other  solid  foods,  the  dose  is  the  size  of  a plum.  If  a nursling 
has  fever,  it  should  not  be  allowed  to  suck,  lest  thirst  develop.  Purga- 
tives and  emetics  are  forbidden,  unless  a disease  threatens  to  take  a 
fatal  turn.  A swollen  and  painful  umbilicus  ( tundi ) is  treated  by 
applying  fomentations,  medicated  oils,  etc.  Special  infantile  elixirs, 
prepared  by  cooking  clarified  butter  with  decoctions  of  various  vege- 
table principles  are  given  to  infants  fed  on  liquid,  semisolid  or  solid 
foods.  The  infant  should  be  carefully  handled,  never  scolded  nor 
roused  suddenly  from  sleep.  It  should  be  fondled  and  amused  with 
toys,  and  never  taken  up  or  laid  down  suddenly.  It  should  not  be 
made  to  sit  upright  too  early,  for  fear  of  deformation.  It  should  not 
be  exposed  to  rain,  the  glare  of  sunlight  or  lightning,  heat,  smoke  or 
dust,  nor  should  it  be  left  under  a tree,  a vine,  in  low-lands,  in  lonely 
houses  or  caves.  The  child  should  always  be  kept  in  the  inner  part  of 
the  house,  and  to  protect  it  from  the  malignant  influences  of  evil  stars 
and  occult  powers,  religious  rites  are  performed. 

Such  are  the  principles  of  pediatrics  in  the  Brahminical  period  of 
Indian  medicine,  a clear,  rational  body  of  doctrine  which  is  not  excelled 
by  that  of  any  other  race  or  nation  before  the  Greeks  or  the  later 
Europeans. 

* Neuburger:  “History  of  Medicine,”  London,  ii  (1910),  p.  56.  The  tendency  to 
give  to  symptoms  andsyn dromes  the  dignityof  definite  diseases  or  “clinical  entities,” 
standing  upon  their  own  feet,  impeded  the  progress  of  medicine  for  a long  time  and 
is  still  chronic  in  certain  quarters.  The  tendency  is  amusingly  illustrated  in  the 
228  varieties  of  syphilis  listed  by  Brassavola.  See  C.  G.  Gruner,  “Morborum 
Antiquitates,”  Breslau  (1774),  pp.  85-100. 


ISRAEL 


27 


ISRAEL 

The  facts  and  findings  of  Jewish  medicine  were  never  cast  into 
the  form  of  a definite  canon,  or  scripture,  but  are  scattered  throughout 
the  Old  and  New  Testaments  and  the  Talmud.  What  we  know  of  the 
subject  is  due  to  the  synthetic  work  of  Thomas  Bartholinus,  Richard 
Meade,  J.  B.  Friedreich,  A.  H.  Israels,  Julius  Preuss,  W.  Ebstein  and 
other  scholars.  The  main  features  of  Biblical  medicine  (Old  Testa- 
ment) are  a clear  recognition  of  contagion  as  a fact,  with  the  institu- 
tion of  prophylactic  measures  against  certain  infectious  diseases  by  the 
high  priests  (as  medical  police),  the  rigid  regulation  of  sexual  hygiene, 
with  medico-legal  expertise  by  the  priests,  and  the  institution  of  the 
Sabbath  as  a weekly  day  of  rest.  In  Talmudic  medicine,  the  presence 
of  an  epidemic  disease  in  a community  was  actually  announced  by 
blast  of  trumpet.  Apart  from  the  foundation  of  preventive  medicine, 
the  ritual  hygiene  and  cult-cleanliness  of  the  Hebrews  were  indeed 
remarkable,  but  are  attributable  to  the  interaction  of  several  cultures 
in  the  8th-6th  Centuries  B.C.,  or  (in  a dictum  of  Huxley’s)  “ only 
one  of  several  sporadic  indications  of  some  powerful  mental  ferment 
over  the  whole  of  the  area  comprised  between  the  dEgean  and  Northern 
Hindustan.”  “What  are  today  considered  fixtures  of  ancient  Semitic 
cult-hygiene,”  says  Sudhoff,  “originated  almost  exclusively  after  the 
Exodus,  therefore  after  the  time  during  which  the  people  of  Israel  had 
been  exposed  for  decades  to  the  influence  of  racially  and  intellectually 
kindred  civilizations  along  the  Euphrates  and  the  Nile.”  Personal 
hygiene  with  intention,  including  athletics  and  cult-cleanliness,  was 
largely  Greek  in  origin.  “Even  ritual  uncleanness  of  women,” 
Sudhoff  insists,  “is  ancient  property  of  Greece.” 

In  the  Old  Testament,  diseases  is  attributed  not  to  demons  but  to 
the  wrath  of  God,  who  alone  can  confer  health.  In  the  New  Testa- 
ment, demons  are  sometimes  exorcised  in  certain  cases  of  “possession.” 

Modern  civilization  flows  from  two  main  streams  of  culture,  the 
Hellenic  and  the  Hebraic.  Hellenism  gave  us  science,  art,  and  the 
principles  of  good  taste;  Judaism  gave  us  religion  and  certain  ethical 
principles  for  regulating  the  conduct  of  our  lives  which  are  the  basis  of 
all  ultimate  strengthening  and  refinement  of  character.  That  the 
Hebrews  set  great  store  by  children  is  everywhere  apparent.  In  the 
Bible,  children  are  a blessing;  childlessness  is  a curse. 

•‘The  children  which  God  hath  graciously  given  Thy  servant”  (Genesis, 
xxxiii,  30). 

“Write  ye  this  man  childless,  a man  that  shall  not  prosper  in  his  days”  (Jere- 
miah, xxii,  30). 

“Lo,  children  are  an  heritage  of  the  Lord;  and  the  fruit  of  the  womb  is  his 
reward”  (Psalms,  cxxvii,  3). 

“Children’s  children  are  the  crown  of  old  men”  (Proverbs,  XVII,  6). 

Tacitus  (History,  V,  5)  ascribes  the  prohibition  of  infanticide  among 
the  Jews  to  their  desire  to  increase  the  population.  * Male  children  were 

* Lecky,  “History  of  European  Morals,”  New  York,  ii  (1869),  p.  28,  footnote  1. 


28 


HISTORY  OF  PEDIATRICS 


especially  valued,  as  future  priests  or  soldiers,  and  a bright,  sagacious 
boy  was  the  joy  of  his  parents: 

“A  wise  son  maketh  a glad  father;  but  a foolish  son  is  the  heaviness  of  his 
mother”  (Proverbs,  X,  1). 

“He  that  begetteth  a fool  doeth  it  to  his  sorrow;  and  the  father  of  a fool  hath 
no  joy”  (Proverbs,  XVII,  1). 

The  feeling  of  all  ancient  civilizations  against  female  offspring  is  sensed 
in  the  impressive  words  of  Jesus  Sirach  (XLII,  9) : 

“A  daughter  is  to  her  father  a secret  sorrow:  care  for  her  welfare  robs  him  of 
his  sleep;  in  her  youth,  that  she  may  not  fade;  in  wedlock,  that  she  be  not  hated; 
in  the  time  of  her  virginity,  that  she  be  not  dishonored,  nor  become  pregnant  in 
her  father’s  house;  in  her  betrothal,  that  she  become  not  frivolous;  in  her  married 
life,  that  she  be  not  sterile.” 

Under  the  stern  moral  and  religious  code  of  Israel,  child-life  was  hedged 
in  from  the  start  by  a veritable  quickset  of  interdictions  and  inhibitions, 
which,  as  evident  from  the  New  Testament,  were  carried  over  into 
Christian  doctrine.  These  teachings  made  for  integrity  and  strength 
of  character,  but  rendered  the  child’s  life  dreary  through  the  prag- 
matic character  of  their  ethical  intention.  The  child  wishes  to  live 
uninhibited  in  an  ideal  frictionless  medium,  but  even  at  the  tenderest 
age,  it  has  to  learn  that  it  cannot. 

“Even  a child  is  known  by  his  ways;  whether  his  work  be  pure  and  whether 
it  be  right”  (Proverbs,  XX,  11). 

“Train  up  a child  in  the  way  he  should  go;  and  when  he  is  old,  he  will  not 
depart  from  it”  (Proverbs,  XXII,  6). 

“A  fool  despiseth  his  father’s  instruction”  (Proverbs,  XV,  5). 

“Children  obey  your  parents”  (Ephesians,  VI,  1;  Colossians,  III,  20). 

“One  that  ruleth  well  his  own  house,  having  his  children  in  subjection  with  all 
gravity”  (Timothy,  III,  4). 

“We  have  had  fathers  of  our  flesh  which  corrected  us”  (Hebrews,  XII,  9). 

“Likewise,  ye  younger,  submit  yourselves  unto  the  elder”  (Hebrews,  V,  5). 

“Now  I say  that  the  heir,  as  long  as  he  is  a child,  differeth  nothing  from  a ser- 
vant, though  he  be  lord  of  all.  But  is  under  tutors  and  governors  until  the  time 
appointed  of  his  father”  (Galatians,  IV,  1-2). 

In  the  older  texts,  rebellious  or  refractory  children  are  viewed  with  the 
severity  of  the  Code  Hammurabi. 

“And  he  that  smiteth  his  father  or  his  mother,  shall  be  surely  put  to  death” 
(Exodus,  XXI,  15). 

“Cursed  be  he  that  setteth  light  by  his  father  or  his  mother”  (Deuteronomv. 
XXVII,  16). 

“The  eye  that  mocketh  at  his  father,  and  despiseth  to  obey  his  mother,  the 
ravens  of  the  valley  shall  pick  out,  and  the  voung  eagles  shall  eat  it”  (Proverbs. 
XXX,  17). 

“Whoso  curseth  father  and  mother,  let  him  die  the  death”  (Mark.  VII.  10). 

In  Deuteronomy  (XXI,  18-21),  a stubborn  and  rebellious  son  shall  be 
stoned  to  death  by  the  elders  of  the  city.  The  little  children  who 
mocked  the  baldness  of  Elisha  were  cursed  by  the  prophet,  and  forty- 
two  of  them  were  torn  by  two  she-bears  that  came  out  of  the  wood 
(II  Kings,  II,  23-24). 

Instances  of  sacrifice  of  the  first-born,  as  in  the  case  of  Abraham  and 
Isaac  (Genesis,  XXII),  or  of  Mesha,  king  of  Moab,  who  sacrificed  the 


ISRAEL 


29 


eldest  son  of  the  king  of  Edom  (II  Kings,  III,  27),  evidently  go  back 
to  remote  antiquity;  for,  as  with  the  Greeks  and  Romans,  this  rite  was, 
in  time,  modified  by  the  substitution  of  some  animal  as  a scapegoat. 
The  hideous  rite  of  passing  children  through  the  fire  to  Moloch  was  of 
Phoenician  origin,  and  practiced  by  the  Carthaginians.  It  fell  upon 
Israel  through  the  insidious  effect  of  contact  with  the  idolatrous  ritual 
of  barbaric  peoples.  Thus,  Ahaz,  king  of  Jerusalem,  “burnt  his 
children  in  the  fire,  after  the  abominations  of  the  heathen  whom  the 
Lord  had  cast  out  before  the  children  of  Israel”  (II  Kings,  XVI,  3; 
II  Chronicles,  XXVII,  3).  Manasseh,  who  ruled  fifty-five  years  in 
Jerusalem,  “made  his  son  pass  through  the  fire.”  The  practice  was 
severely  denounced  in  the  fulminations  of  the  Hebrew  prophets: 

“For  when  ye  offer  your  gifts,  when  ye  make  your  sons  to  pass  through  the 
fire,  ye  pollute  yourselves  with  all  your  idols,  even  unto  this  day”  (Ezekiel,  XX, 
31). 

“Against  whom  do  ye  sport  yourselves?  Against  whom  do  ye  make  a wide 
mouth,  and  draw  out  the  tongue?  Are  ye  not  the  children  of  transgression,  a 
seed  of  falsehood, 

Inflaming  yourselves  with  idols  under  every  green  tree,  slaying  the  children 
in  the  valleys  under  the  clefts  of  the  rocks?”  (Isaiah,  LVII,  4-5). 

• “Yea,  they  sacrificed  their  sons  and  their  daughters  unto  devils,  and  shed 
innocent  blood,  even  the  blood  of  their  sons  and  daughters,  whom  they  sacrificed 
into  the  idols  of  Canaan:  and  the  land  was  polluted  with  blood”  (Psalms,  CV1, 
37-38). 

Our  knowledge  of  ancient  Jewush  pediatrics  is  mainly  drawn  from 
that  great  body  of  scholastic  and  mystic  commentation  on  the  five 
books  of  the  Mosaic  law  (Torah  or  Pentateuch)  which  began  to 
accumulate  after  the  Babylonian  captivity  (536  B.C.)  and  which  makes 
up  the  Talmud.  In  contradistinction  to  the  written  law  of  the  Torah, 
the  Talmud  consists  of  the  law  transmitted  by  verbal  tradition 
(Mishna)  with  its  many  interpretations  and  commentaries  (Gemara). 
There  are  two  Talmuds:  The  Palestinian,  completed  370-390  A.D., 
and  the  Babylonian,  completed  352-427  A.D.  The  Babylonian 
Talmud  is  the  Talmud  of  ordinary  reference. 

In  the  Talmudic  ritual  which  attended  the  ushering  of  the  new-born 
child  into  the  world,  there  is  evidence  of  ancient  practice,  and  also  of 
superstition.  If  the  child  was  born  with  a caul,  it  was  a sign  of  good 
luck.  If  it  was  a boy,  he  was  greeted  with  the  phrase:  “A  blessing 
has  come  into  the  world;”  if  it  was  a girl,  “the  walls  wept.”  A cedar 
tree  was  planted  at  the  birth  of  a boy;  a pine  tree  for  a girl.  The 
Shema  or  Psalm  XC  was  read  in  the  presence  of  the  children  of  the 
community  for  the  protection  of  the  new-born.  There  wTere  visitations 
to  the  infant  boy  on  the  first  Sabbath  of  his  life.  In  Talmudic  times, 
the  infant  was  weighed  and  its  body-weight  in  coins  was  given  to  the 
poor.  Amulets  and  charms,  such  as  the  suspension  of  Torah  scrolls  or 
verses  of  the  Psalms  over  the  bed,  or  the  chalking  of  circles  on  the  wall 
or  the  floor  of  the  lying-in  room,  were  in  evidence.  The  cradle  was 
sometimes  hung  with  bells  to  ward  off  evil,  a feature  of  the  amulets  of 
modern  Spain.  The  ceremonial  of  “redemption  of  the  first-born” 


30 


HISTORY  OF  PEDIATRICS 


came  on  the  thirty-third  day  after  the  birth  of  a male,  and  the  sixtieth 
day  after  the  birth  of  a female.  The  child’s  hair  was  not  cut  until 
its  fourth  birthday,  lest  it  acquire  an  elf-lock.  Its  religious  instruction 
began  in  the  fourth  year.  It  had  to  learn  the  Torah  at  five,  the  Mish- 
nah  at  ten,  and  “fulfilled  the.  whole  Law”  at  thirteen.  Girls  as  well  as 
boys  were  sent  to  the  synagogue,  where  both  were  kept  apart,  as 
showing  scant  reverence  through  their  playful  impulses.  Swimming 
and  handicraft  were  taught,  but  the  Jewish  children  acquired  their 
games  from  the  people  among  whom  they  were  living.*  The  cradle- 
songs usually  enjoin  upon  the  infant  that  it  study  the  Torah.  The 
following  little  berceuse,  translated  from  the  Yiddish  in  the  Jewish 
Encyclopedia, f has  the  spirit  of  “A  Child’s  Garden  of  Verses,”  and 
suggests  that  bears  were  fearsome  objects  to  Eastern  European 
children: 

“Beggars  and  bears  are  all  around; 

They  even  walk  around  outside, 

And  if  they  find  pretty  girls  are  crying 

They  seize  them  and  throw  them  into  the  well.” 

On  the  day  after  birth,  circumcision  was  performed  upon  male 
children  of  freemen  and  slaves,  in  token  of  the  covenant  between  God 
and  Abraham.  In  Biblical  times,  the  operation  was  performed  by  the 
mother,  usually  with  a primitive  chipped  flint  (Exodus,  IV,  25).  The 
rite  was  not  in  the  nature  of  a sacrament,  but  was  regarded  as  indis- 
pensable to  consecration  and  purification.  To  be  uncircumcised  ( arel ) 
was  a reproach,  but  an  uncircumcised  Jew  still  remained  a Jew. 
Aliens  had  to  be  circumcised  before  they  could  partake  of  the  Passover 
(Exodus,  XII,  48)  or  marry  a Jewish  woman  (Genesis,  XXXIV, 
14-16).  The  rite  can  be  performed  by  a physician  as  well  as  a priest. 
In  the  time  of  Josephus,  it  was  in  the  hands  of  a surgeon  ( mohel ).  The 
rite  of  circumcision  originated  in  Egypt.  All  that  came  out  of  Egypt 
were  circumcised  (Exodus,  IV,  24-26),  but  those  who  came  out  of 
the  Wilderness  were  not  (Joshua,  V,  2-9).  Circumcision  is  a wide- 
spread custom  throughout  the  Mohammedan  world,  was  probably 
acquired  by  the  Aztecs  by  the  convection  of  Egyptian  culture  (Elliot 
Smith),  J is  common  in  Australia,  Northern  and  Central  Africa,  among 
the  Amazon  tribes  of  South  America  and  the  Polynesians  of  the  South 
Seas.  Aboriginally,  it  is  a rite  of  initiation  or  consecration  of  the 
generative  powers  at  puberty.  In  the  Jewish  ritual,  it  has  three 
stages:  the  excision  of  the  foreskin  ( milah );  the  rolling  back  of  the 
prepuce  (; periah ),  and  the  sucking  of  the  wound  (rnezizah),  which  has 
sometimes  exposed  the  infant  to  inoculation  with  syphilis.  The 
necessity  of  circumcision  in  proselytes  was  abolished  in  1892. § 

At  birth,  the  Jewish  child  was  washed  in  water,  rubbed  with  salt, 
given  the  breast  even  before  cutting  the  umbilical  cord,  and  wrapped 

* Jewish  Encyclopedia,  New  York,  iv  (1903),  pp.  27-31. 

t Ibid.,  p.  332. 

J G.  Elliot  Smith,  “The  Migrations  of  Early  Culture,”  Manchester  (1915). 

§ Jewish  Encyclopedia,  New  York,  iv  (1903),  pp.  92-102. 


ISRAEL 


31 


in  swaddling  clothes.  This  procedure,  essential  in  the  Talmud,  is 
preserved  even  in  the  imprecations  of  Ezekiel  against  Jerusalem: 

“And  as  for  thy  nativity,  in  the  day  thou  wast  born,  they  navel  was  not  cut, 
neither  wast  thou  washed  in  water  to  supple  thee;  thou  wast  not  salted  at  all, 
nor  swaddled  at  all”  (Ezekiel,  XVI,  4). 

The  salting  of  the  child,  which  was  also  a custom  of  the  Greeks,  was 
thought  to  give  it  a thicker,  tighter  skin  (Galen),  with  immunity 
from  eruptions.  Osiander  thought  the  “salt”  was  bicarbonate  of 
soda,  which  forms  a soap  with  the  vernix  caseosa.  In  Talmudic  times, 
the  new-born  infant  was  also  bathed  in  wine.  If  it  made  no  sound,  it 
was  rubbed  with  the  afterbirth.  If  the  child  did  not  breathe,  it  was, 
according  to  the  Babylonian  Talmud,  swung  in  a swing,  probably  the 
method  for  relieving  asphyxia  neonatorum  introduced  by  C.  B. 
Schultze  (1871).  If  it  refused  the  breast,  a beaker  with  hot  coals  was 
held  near  its  mouth  to  stimulate  the  facial  muscles.  The  swaddling  of 
the  child,  known  as  laphaph  in  the  Talmud,  consisted  in  compressing  its 
body  into  a rigid  mummy-like  mold  by  a system  of  tight  bandages. 
The  intention  was  perhaps  orthopedic,  as  the  head  was  also  compressed 
to  make  it  long  or  round.  The  mouth  was  washed  to  incite  vomiting  of 
mucus.  In  the  daytime,  the  child  was  rocked  in  its  cradle;  at  night, 
it  slept  with  its  mother,  whence  there  was  danger  of  suffocation  by 
overlying. 

In  the  third  month  of  pregnancy,  it  was  supposed  by  the  Greeks, 
the  Hebrews  and  the  Arabs  that  suppression  of  the  menses  acquired  an 
economic  function;  the  menstrual  blood  clouded  to  become  milk. 
According  to  Jewish  custom,  the  child  was  given  the  maternal  breast 
immediately  or  within  24  hours  after  birth,  even  if  the  cord  had  not 
been  cut,  which  is  different  from  ancient  Greek  and  Indian  practice. 

The  ancient  belief  that  honey  purges  the  new-born  of  meconium 
is  preserved  in  Isaiah (VII,  14,  15): 

“Behold  a virgin  shall  conceive,  and  bear  a son,  and  shall  call  his  name  Imman- 
uel. Butter  and  honey  shall  he  eat,  that  he  may  know  to  refuse  the  evil,  and 
choose  the  good.” 

Talmudic  theory  maintains  that-  the  child  can  suck  all  day  without 
harm.  The  night  was  divided  into  three  watches,  and  in  the  third 
watch,  before  dawn,  the  infant  was  given  the  breast.  The  child  was 
suckled  for  a period  of  18  months  or  two  years.  In  the  second  book 
of  Macabees  (VIII,  27),  a mother  tells  her  son  that  she  suckled  him  for 
three  years.  Rabbi  Joshua  held  that  breast-nourishment  may  con- 
tinue for  an  unlimited  period,  even  five  years,  if  necessary.  Sarah 
suckled  her  son  Isaac  at  the  age  of  ninety  (Genesis,  XXI,  7-8). 
Breast-nursing  was  regarded  as  a primal  duty  of  the  mother  by  the 
Hebrew  prophets: 

“Can  a woman  forget  her  sucking  child,  that  she  should  not  have  compassion 
on  the  son  of  her  womb*”  (Isaiah,  XLIX,  15). 

“Even  the  sea  monsters  draw  out  the  breast,  they  give  suck  to  their  j-oung 
ones;  the  daughter  of  thy  people  is  become  cruel,  like  the  ostriches  in  the  wilder- 
ness. The  tongue  of  the  sucking  child  cleaveth  to  the  roof  of  his  mouth  for  thirst; 


32 


HISTORY  OF  PEDIATRICS 


the  young  children  ask  bread  and  no  man  breaketh  it  unto  them”  (Lamentations, 
IV,  3-4). 

If  the  husband  of  a nursing  mother  died,  she  was  not  allowed  to  marry 
again  within  18-24  months,  lest  a new  pregnancy  interfere  with  the 
nourishment  of  the  first  child.  The  time  limit  for  lactation  also 
determined  the  minimum  period  within  which  a widow  could  marry. 
If  the  mother  died,  the  father  could  provide  artificial  nourishment  fa- 
ins infant,  but  these  things  could  not  be  entrusted  to  a step-father. 
The  ancients  did  not  credit  the  theory  that  lactation  hinders  concej'- 
tion.  The  ethical  ideal  was  that  specified  in  Hosea  (I,  8): 

“Now  when  she  had  weaned  Loruhamah,  she  conceived  and  bare  a son.  ’ 
A rabbi  would  not  allow  a widow  whose  infant  had  died  to  marry 
until  24  months  after  its  birth,  because  a certain  widow  had  once 
made  away  with  her  child  in  order  to  marry  earlier.  No  wife  was 
required  to  suckle  her  neighbor’s  child.  If  there  were  twins,  one 
was  suckled  by  a wet-nurse.  It  was  adjudged  shameless  to  suckie 
infants  in  public.  If  a husband  forbade  his  wife  to  suckle  her  chil 
her  will  and  pleasure  obtained  in  the  matter,  since  the  labor  and  troub! 
were  all  her  own.  If  she  declined  to  suckle  her  infant  on  her  ov. 
account,  the  case  was  decided  by  the  custom  obtaining  in  her  famil 
If  the  mother  was  not  capable  of  suckling,  on  account  of  sickness  or 
otherwise,  a wet-nurse  was  engaged,  usually  a slave  or  hired  woman. 
As  in  the  Alexandrian  slave  contracts,  she  was  engaged  for  2-3  yea:  s, 
undertook  no  other  occupation,  and  suckled  no  other  child,  not  even 
her  own.  Whether  a nurse  alien  to  the  Jewish  faith  could  be  employed 
was  disputed  by  the  rabbis.  She  might  kill  the  child  by  rubbing 
poison  on  her  breasts.  The  Jewish  women  seldom  employed  ah  n 
nurses  as  their  breasts  were  well  developed.  When  Moses  was  foun  i 
by  Pharaoh’s  daughter  in  the  ark  of  buhrushes,  his  mother  was  secur 
as  his  wet-nurse  by  the  stratagem  of  his  father’s  sister  (Exodus,  II, 
7-9).  A Wet-nurse  was  held  responsible  for  the  fate  of  the  nursling. 
Like  Deborah,  the  nurse  of  Rebekah,  she  was  regarded  as  a member  of 
the  family  and  held  in  esteem,  if  competent.  During  lactation,  a 
nursing  woman  worked  little  and  fed  well.  She  might  take  wine,  bi  r 
no  articles  which  might  spoil  the  milk  or  lessen  the  supply  of  it.  Hops, 
green  corn,  figs,  small  fish,  etc.,  were  interdicted.  A supply  of  “puie 
unadulterated  milk”  was  specified  in  the  Alexandrian  wet-nursi 
contracts.  Both  wet-nurses  and  nursing  mothers  had  to  observe  t 
fast-days.  There  is  no  mention  of  artificial  feeding  in  the  Talmu 
The  child  must  have  milk  or  die.  The  mother’s  milk  was  sometin  .es 
milked  from  the  breasts  and  given  in  a glass  or  the  horn  of  an  animal, 
in  the  case  of  a new  pregnancy.  Sucking  immediately  from  the  udd  - 
of  a cow  or  goat  was  customary  in  antiquity,  as  in  the  mytho- 
logical instances  of  the  Egyptian  cow-goddess  Hathor,  or  of  Zeus  a • 1 
Amalthea,  or  Romulus  and  Remus.  Suckling  from  the  male  breast 
is  recorded  in  one  case  in  the  Talmud.  There  is  no  evidence  of  the 
existence  of  nursing  bottles,  although  they  were  employed  in  Rome  ana 
Alexandria.  At  the  weaning  of  the  child,  the  Hebrews  in  the  desert 


ISRAEL 


33 


held  a least  (Genesis,  XXI,  8;  I Samuel,  I ,24-  25).  This  practice, 
however,  disappeared  in  Talmudic  times.* 

Beyond  the  case  of  the  raising  of  the  widow’s  son  by  Elijah  (I  Kings, 
XVII,  17-23),  the  resuscitation  of  the  son  of  the  Shunammite  woman 
by  Elisha  (II  Kings,  IV,  18-35),  which  Preuss  surmises  to  have  been  a 
case  of  sunstroke,  and  the  raising  of  the  daughter  of  Jairus  by  Jesus 
' Matthew,  IX,  18,  23-25),  there  is  little  mention  of  children’s  diseases 
iri  the  Old  or  the  New  Testament.  Of  the  many  diseases  mentioned  in 
e Talmud,  the  most  dangerous  to  children  was  the  askara  ( eaKapa ) or 
serunke  (<rvvayxv),  that  is,  cynanche,  squinantia  (quinsy)  or  diphtheria, 
identical  with  the  “Egyptian  or  Syrian  ulcer”  of  Aretaeus.  So  much 
was  this  disease  feared  by  the  Hebrews  that  the  first  case  located  in  a 
community  was  immediately  heralded  by  a warning  blast  of  the 
trumpet,  although  the  shofar  was  usually  sounded,  under  ordinary 
circumstances,  only  after  the  third  case  of  an  epidemic  disease.  The 
painful  struggling  of  the  suffocating  patient  was  regarded  as  the  most 
terrible  of  the  903  known  varieties  of  death.  Rabbi  Josef  said  that 
whoever  was  guilty  of  strangling  a person  to  death  would  either  be 
drowned,  strangled  by  the  heathen,  or  die  of  serunke.  Rabbi  Ismael 
ben  R.  Jose  describes  the  disease  as  follows: 

“ Askara  is  a much-dreaded  epidemic  disease  which  usually  attacks  children, 
is  located  in  the  throat,  and  kills  the  patient  by  a painful  death  from  suffocation.” 

To  avert  it,  there  was  an  apotropaic  diet:  lentils  were  eaten  daily, 
all  food  was  salted  and  water  mixed  with  every  drink.  Lentils  or 
juice  of  lentils  were  recommended  as  a remedy  by  Rabbi  Jochanan. 
During  the  Temple  period,  the  priest  on  guard  fasted  every  Wednesday 
to  prevent  children  from  catching  the  disease.  In  the  Karaitic 
prayer-book,  there  is  the  following  verse  for  Wednesday: 

“And  askara,  which  Thou  hast  joined  to  this  day:  protect  the  children  of  Thy 
people  from  it,  that  it  may  not  come  into  their  mouths.” 

Dysentery  ( choli  ‘ ajlm ) was  also  much  feared,  and  was  doubtless 

of  the  tropical  variety.  Another  disease  affecting  childhood  and  youth 
was  the  jeraquon  (pallid  anemia).  Heat-stroke  in  a three-year  old  boy 
at  harvest  time,  with  cerebral  symptoms,  has  already  been  noted 
(II  Kings,  IV,  18).  Biliary  disorders  (choli),  jaundice  in  particular, 
were  common  complaints  throughout  the  Jewish  and  Mohammedan 
world.  They  were  treated  by  a mixture  of  barley,  Carthamus  tinc- 
torius,  and  salt  (Rabbi  Josef).  This  draught,  which  the  Gemara 
declared  to  be  identical  with  the  Egyptian  zythos,  was  called  “spear- 
water”  (me  dequarin),  because  it  penetrated  the  bile.  Dropsy  (hadro- 
quan),  intestinal  worms  (kinnim),  phthiriasis  (rimma),  scorbutic 
stomatitis  ( caphdina ) are  features  of  Talmudic  medicine.  Beautiful 
t -eth  and  an  odorless  breath  were  a personal  ambition.  Fedor  ex  ore 
nulled  marriage  in  a woman,  and  annuls  even  a betrothal  in  Prussian 

* These  details  are  derived  from  J.  Preuss:  “ Biblisch-Talmudische  Medizin,” 
Berlin  (1911),  pp.  466-477;  W.  Ebstein:  “Die  Medizin  im  alten  Testament,” 
ttgart  (1901),  pp.  64-67;  and  Ebstein:  “Die  Medizin  im  neuen  Testament 
und  im  Talmud,”  Stuttgart  (1903),  pp.  216-219. 

Vol.  1—3 


34 


HISTORY  OF  PEDIATRICS 


law.  The  foul  breath  of  the  adulteress  was  an  observation  of  the 
Talmud  (Numeri,  r.  IX,  21).  To  keep  the  breath  odorless,  mastix 
was  chewed,  pepper,  cinnamon  or  ginger  were  held  in  the  mouth,  and 
the  teeth  were  rubbed  with  a dry  powder.  Toothache  and  dental 
caries  were  treated  by  boring,  scraping  away  tartar  and  implantation 
of  artificial  teeth.  Gargles  were  given  for  tonsillitis  and  laryngitis 
( garon ).  Milk  was  drunk  frankly  from  the  udders  of  the  goat  for  lung 
affections,  but  there  are  no  words  for  “cough”  or  “phthisis”  in 
Hebrew.  The  arid  plains  of  Palestine  were,  from  of  old,  inimical  to 
pulmonary  disease  (Liebermeister).* 


HELLAS 

In  the  Homeric  Period  (950  B.C.),  infants,  when  not  exposed, 
were  usually  nursed  by  their  own  mothers.  Thus  Hecuba  reminds 
Hector  how  she  once  gave  him  “the  grief-lulling  breast”  {Iliad,  XXII, 
82-83);  Achilles  is  described  as  one  “whose  mother  nurtured  him  in 
wrath”  (XVI,  203)  and  there  is  reference  to  Penelope  as  a young  bride 
with  “an  infant  boy  at  her  breast”  ( Odyssey , XI,  448).  Among  the 
upper  classes,  slave-nurses,  sometimes  captive  women,  were  also 
employed.  Odysseus  says  to  his  aged  nurse  Eurycleia:  “ Why  dost  thou  ' 
wish  to  destroy  me?  Thou  thyself  didst  nourish  me  at  thy  breast” 
(XIX,  482),  and  we  learn  that  Eurycleia  had  been  purchased  by  Laertes 
in  her  youth  for  a hundred  beeves  (I,  9),  and  that  she  rose  to  high 
rank  in  the  household,  supervising  the  fifty  female  slaves  (XXII,  421). 
The  nurse  in  Homeric  life  was,  like  the  nurse  in  “ Romeo  and  Juliet,”  a 
member  of  the  family,  indeed  the  general  housekeeper.  Thus  De- 
meter, in  the  Homeric  hymn  (141-144): 

“And  truly  I could  fitly  nurse  a young  infant,  having  him  in  my 
arms,  and  could  take  care  of  the  house  and  could  spread  my  master’s  bed 
in  the  recess  of  the  well-built  chambers,  and  could  manage  the  works  of  woman.” 

For  such  service,  as  we  learn  from  the  same  hymn  to  Demeter  (166), 
even  a slave-nurse  was  richly  rewarded.  The  nurse’s  duties  to  the 
infant  were  to  bathe  it  in  water  immediately  after  birth,  to  wrap  it  in 
swaddling  clothes,  usually  of  white,  purple  or  saffron  color,  with  gold 
bands  (Hymn  to  Apollo,  121),  to  fondle  it  and  carry  it  about,  and  to 
suckle  it  until  it  could  be  fed  on  honey  or  the  juice  of  figs.  Care  was 
taken  to  carry  the  child  until  it  could  stand  and  walk  without  distorting 
its  limbs.  It  was  carefully  washed  and  dressed,  and  cradled  in  a shield, 
a shoe-shaped  two-handled  basket,  or  in  a basket  woven  of  twigs  for 
winnowing  corn  (At kvov),  which,  as  being  sacred  to  the  gods,  was 
regarded  as  a symbol  of  future  wealth  and  prosperity.  Dolls,  rattles, 
balls,  animals  made  of  clay,  and  other  toys  were  provided,  and  stories, 
designed  to  form  the  child’s  mind,  were  told,  even  down  to  the  time  of 

* J.  Preuss:  “ Biblisch-talmudische  Medizin,”  Berlin  (1911),  pp.  172-433, 
passim. 


HELLAS 


35 


Galen  (De  temper amentis,  II,  578).  As  a rule,  the  nurse  remained  the 
devoted  attendant  of  the  grown-up  son  or  daughter  in  after-life.* 

As  set  forth  in  the  laws  of  Lycurgus  (880  B.C.),  which  are  said 
to  have  been  based  upon  his  observations  in  Crete,  Ionia,  and  Egypt, 
the  children  of  Sparta  were  reared  in  a different  manner  from  that 
obtaining  in  the  aristocratic  milieu  of  the  Iliad  and  the  Odyssey.  In 
Plutarch’s  life  of  Lycurgus,  we  read  that  eugenics,  or  the  securing  of 
a vigorous  parentage  to  offspring,  was  practised  without  any  regard 
for  conventional  morality ; that  “ children  were  not  so  much  the  property 
of  their  parents  but  of  the  whole  commonwealth”;  and  that  puny, 
ill-formed  children  were  exposed  in  a chasm  under  Mount  Taygetus, 
since  it  was  “neither  for  the  good  of  the  child  itself,  nor  for  the  public 
interest  that  it  should  be  brought  up,  if  it  did  not,  from  the  very  outset, 
appear  made  to  be  healthy  and  vigorous.” 

“Upon  the  same  account,  the  women  did  not  bathe  the  newborn  children  with 
water,  as  is  the  custom  in  all  other  countries,  but  with  wine,  to  prove  the  temper 
and  complexion  of  their  bodies;  from  a notion  they  had  that  epileptic  and  weakly 
children  waste  away  upon  their  being  thus  bathed,  while  on  the  contrary,  those  of  a 
strong  and  vigorous  habit  acquire  firmness  and  get  a temper  by  it,  like  steel. 
There  was  much  care  and  art,  too,  used  by  the  nurses:  They  had  no  swaddling 
bands;  the  children  grew  up  free  and  unconstrained  in  limb  and  form,  and  not 
dainty  and  fanciful  about  their  food;  not  afraid  in  the  dark,  or  of  being  left  alone; 
without  any  peevishness  or  ill  humor  or  crying.  Upon  this  account,  Spartan 
nurses  were  often  brought  up  or  hired  by  people  of  other  countries;  and  it  is 
recorded  that  she  who  suckled  Alcibiades  was  a Spartan.”  f 

Up  to  the  age  of  seven,  male  children  were  kept  in  the  gynaeceum 
under  the  care  of  women;  from  7 to  18  they  were  called  “boys” 
(jrpwTeipes  from  18  to  30  “youths”  (e0?j|8ot),  at  30,  they  attained  to 
manhood.  Education  of  boys  was  mainly  physical — running,  leaping, 
wrestling,  boxing,  etc.,  and  was  conducted  in  a gymnasium.  Dancing, 
military  exercises  and  the  chase  made  up  the  rest.  At  the  festival  of 
Diana  Orthia,  the  flogging  of  certain  boys  ( 8i.ap.aoTLyuxns ) was  practised 
to  teach  endurance  to  pain.  Girls  also  wrestled,  ran  races,  threw 
quoits,  cast  spears  and  danced  in  public  in  a state  of  nudity;  and,  as 
Sudhoff  says,  “the  regulation  of  sexual  life  in  the  gymnastic  exercises 
of  girls  was  divorced  from  prudery  and  had  a definite  eugenic  aim: 
vigorous  offspring.”!;  Out  of  this  stock  came  alike  the  heroes  who 
fought  at  Thermopylae,  and  “Heaven-born  Helen,  Sparta’s  queen,” 
whose  fatal  gift  of  beauty  caused  the  Trojan  war. 

In  Hellenistic  Athens,  infants  were  wet-nursed  not  only  by  slaves 
and  captives,  but  also  by  free  women,  usually  through  poverty  and 
the  necessity  of  supporting  dependents  in  this  manner.  But  even 
when  slave-nurses  were  set  free,  they  still  remained  in  the  service 
of  their  masters,  and  like  the  free-born  woman  of  the  metic  class, 

* These  details  have  been  brought  together  in  the  graduating  dissertation  of 
Sister  Mary  Rosaria  on  “The  Nurse  in  Greek  Life  ’’(Boston,  1917),  an  admirable 
summary. 

t Plutarch’s  Lives  (A.  H.  Clough),  sub  voce  “Lycurgus.” 

t Sudhoff:  Ann.  Med.  History,  N.  Y.,  i (1917)  p.  112;  translation  of  Dr.  Frank 
J.  Stockman. 


36 


HISTORY  OF  PEDIATRICS 


received  a living  wage.  Foreign  nurses  were  sometimes  employed  by 
the  Athenians.  The  Spartan  women  were  usually  preferred,  on  account 
of  their  robust  physique  and  their  sturdy,  wholesome  natures.  Aris- 
totle attributed  infantile  diseases  to  faulty  diathesis  in  the  nurse 
(Historia  animalium,  VII,  10).  Corinthian  and  Phrygian  women  were 
also  favored,  and,  like  all  metics,  received  compensation.*  The 
practice  of  swaddling  the  infant  continued  down  to  the  late  Roman 
period,  was  described  in  detail  by  Soranus,  and  was  carried  over  into 
medieval  custom.  It  was  derided  by  Plato,  who  proposes  that  nurses 
should  be  compelled 

“under  penalty  of  a legal  fine  to  be  always  carrying  the  children  somewhere 
or  other,  either  in  the  country,  or  to  the  temples,  or  to  their  relations’  houses, 
until  they  are  well  able  to  stand  and  even  then  they  should  be  careful  that  their 
limbs  are  not  distorted  by  leaning  on  them  when  they  are  too  young.  They  should 
continue  to  carry  them  until  the  infant  has  completed  its  third  year”  (Laws, 
IV,  789). 

In  the  same  passage  he  likens  the  effects  of  dandling  and  rocking 
of  infants  to  the  soothing,  restful  movements  of  a swing,  horseback 
riding  or  the  sea.  Further,  he  says  that  nurses  judged  of  the  mood 
of  a child  by  the  effect  of  something  offered  it:  when  it  is  silent, 
it  is  pleased;  when  it  weeps  and  cries  out,  it  is  angry  (792).  The 
use  of  wine,  by  nurse  as  well  as  child,  was  condemned  by  Aristotle 
(Politics,  VII,  7),  and  Hippocrates  says  \De  aere,  aquis  et  locis,  I,  9)f 
that  to  avoid  the  formation  of  calculus  by  unwholesome  milk,  it 
is  better  to  give  children  wine  copiously  diluted  with  water,  as  this 
beverage  tends  less  to  burn  and  dry  up  the  veins.  Amulets  and 
charms  against  witchcraft  were  still  used,  and  the  nurse  commonly 
spat  toward  an  approaching  stranger  to  ward  off  the  evil  eye  or  other 
malevolent  influence  (fjiaa, ua)  which  might  emanate  from  his  person. 
The  nurse  taught  the  child  to  distinguish  objects  by  their  names, 
spanked  it  with  the  sandal  on  occasion  (Lucian),  and  told  it  the  usual 
nursery  tales.  To  frighten  into  good  behavior,  gruesome  stories  wTere 
told  about  Lamia,  the  vampire,  who  devoured  children  alive,  the 
Gorgon,  the  minions  of  Hecate,  the  Cyclops  and  other  terrifying 
figures.  To  amuse  children  or  put  them  to  sleep,  mythological  stories 
were  told,  such  as  the  infancy  of  Hermes,  the  adventures  of  Odysseus 
or  the  labors  of  Hercules.  Plato,  in  the  Republic  (II,  377-383), 
Aristotle  and  Plutarch  discourse  at  great  length  upon  the  importance  of 
censoring  the  episodes  in  Greek  mythology  as  tales  for  the  young,  so 
that  what  was  immoral  and  pernicious  might  be  avoided.  The  Greek 
lullabies  for  infants  were  probably  rhythmic  songs  without  words 
(Aristotle)  or  with  word  improvised  by  the  nurse.  Beautiful  examples 
are  found  in  the  poets,  such  as  the  lullaby  of  Alcmena  in  Theo- 
critus (XXIV,  6-8),  the  Lament  of  Danae  in  Simonides  (Fr.  37), 
or  the  nurse’s  song  in  the  Orestes  of  Euripides  (174-182). J 

* Sister  Mary  Rosaria,  op.  cit.}  pp.  12-15. 

f Littre’s  Hippocrates,  ii,  p.  41. 

t Sister  Mary  Rosaria,  op.  cit.,  pp.  34-44. 


HELLAS 


37 


Over  all  child-life  in  Greece,  Homeric,  Spartan,  or  Athenian,  was 
the  glorious  plein  air  of  Hellenic  culture.  Innumerable  terra  cotta 
figurines  and  reliefs  exist,  representing  the  suckling,  dandling,  bathing 
and  fondling  of  infants,  the  games  of  children,  and  the  amulets 
employed  to  protect  them  (Dresden  Catalogue,  items  4051-4212). 
Sudhoff  summarizes  as  follows: 

“Even  though  the  exposure  of  weakly  or  unwelcome  children,  in  Greece 
(Sparta)  and  Italy,  as  well  as  in  the  Orient,  left  an  ineradicable  stain,  yet  the  Greek 
upbringing  of  children,  in  its  harmonious  development  of  body  and  spirit,  is  a 
Wonderful  phase  of  hygiene.  The  love  which  invested  the  earliest  period  of 
child-life  is  apparent  in  the  profusion  of  imagery  which  tells  of  the  first  bath  of  the 
new  born,  its  swathing  and  cradling,  the  suckling  of  the  infant  at  the  breast  of 
mother  or  wet-nurse.  In  the  later  period  of  Hellenistic  Egypt,  infants  were  in 
care  of  wet-nurses,  who  gave  them  six  months  breast-nourishment  and  eighteen 
months  of  artificial  milk-diet,  as  attested  by  the  many  nursing  bottles  which 
continue  to  be  found  in  children’s  graves.  The  same  principles  applied  to  infant 
nutrition  in  Confederated  Hellas,  but  the  children  remained  at  home  in  charge  of 
mother  or  wet-nurses,  among  whom  the  Spartan  women  were  particularly  prized, 
although  the  Spartan  habit  of  rearing  without  swaddling  clothes  does  not  appear 
to  have  taken  hold  elsewhere.  In  children’s  games  of  all  kinds,  the  Greek  spirit 
was  everywhere  inventive.  The  plaything  was  often  designed  for  games  of  run- 
ning and  jumping;  with  older  children  the  ball,  the  hoop,  the  peg-top  were  as 
popular  as  with  adults  of  both  sexes;  as  also  the  swing,  the  see-saw,  the  kite,  the 
hobby-horse,  the  go-cart,  pitch  and  toss,  etc.,  which  were  carried  over  directly 
into  the  gymnastic  exercises  of  later  years.”* 

In  Greek  medicine  before  the  time  of  Soranus  of  Ephesus,  the 
pediatric  element  is  scattered  at  random  through  the  literature,  as 
with  the  pediatrics  of  the  Talmud.  Greek  medicine,  as  a contribution 
to  science,  begins  with  Hippocrates  (460-370  B.C.). 

A strange  superstition  of  antiquity  was  to  the  effect  that  a seven- 
months  child  is  sometimes  viable,  but  an  eight-months  child  undergoes 
certain  pathological  changes  in  the  uterus,  due  to  sinking  and  altered 
relation  of  the  fetus  in  utero,  which  renders  it  unfit  for  birth  and  extra- 
uterine  life.  A ten-months  child  was  regarded  as  more  vigorous  and 
fit  for  life  than  even  a nine-months  child.  Discussion  of  this  matter 
forms  the  theme  of  the  Hippocratic  treatises  on  the  seven-  and  eight- 
months  child. 

In  the  Hippocratic  canon,  there  are  innumerable  references  to  the 
hygiene  and  diseases  of  infancy  and  childhood. 

Thus  in  the  apocryphal  books  on  Epidemic  Diseases  (IV- VII)  we  find  cases 
diagnosed  by  Littre  as  opening  the  chest  by  cauterization  for  empyema  in  a child  of 
Philis  (IV,  4);  head  injury  in  a son  of  Metrophantus,  with  fever,  trephining  and 
death  on  the  24th  day  (IV,  11);  gangrene  of  the  mouth  in  two  children  (IV,  19); 
disease  of  the  bladder  in  a son  of  Theophorbus  of  Larissa  (V,  17);  fatal  impalement 
of  a child  by  a boar’s  tusk  (V,  39);  phagedenic  ulcer  of  the  mouth  in  a son  of 
Athenades  (V,  44);  fatal  tetanus  from  a sprain  in  Telephanes,  son  of  Harpalus 
(V,  75);  and  from  irritation  of  a wound  by  a drug  in  Thrino,  son  of  Damon  (V,  76); 
gangrene  of  the  jaw  from  toothache,  in  a child  of  Metrodorus  of  Cardia  (VI,  100); 
meningitis  from  caries  of  the  petrous  portion  of  the  mastoid  (VII,  5);  an  epileptic 
fit  in  a son  of  Anechetus  (VII,  46) ; and  an  umbilical  fistula  with  procidence  of  the 
intestine  in  a child  of  Dinias  of  Abdera  (VII,  117). 

* Sudhoff:  Dresden  Catalogue  (1911),  p.  138. 


38 


HISTORY  OF  PEDIATRICS 


In  the  genuine  books  on  Epidemic  Diseases  (I— III) , there  are  authentic 
and  valuable  descriptions  of  the  semeiology  of  phthisis,  dysentery  and 
diarrheal  diseases,  malarial  and  hsemoglobinuric  fevers,  gangrenous 
erysipelas  and  ergotism,  epidemic  parotitis  and  anthrax.  In  the 
account  of  epidemic  parotitis  in  the  island  of  Thrasos,  the  simulta- 
neous painful  swellings  in  the  salivary  glands  and  testicles  were  already 
noted,  although  the  orchitis  was  first  featured  as  such  by  Hamilton 
in  1761.  The  Hippocratic  treatise  on  the  joints  ( irepl  apdpuv)  is  a 
scientific  account,  almost  modern,  of  the  different  congenital  deformi- 
ties of  the  foot  and  spine  and  the  various  dislocations  and  their  treat- 
ment. In  this  treatise  (§41),  and  in  the  Aphorisms  (VI,  46),  it  is 
noted  that  a gibbous  spine  (Pott’s  disease)  often  coexists  with  tubercu- 
losis of  the  lungs;  and  the  Calot  treatment  of  spinal  deformity  by  for- 
cible reduction  (redressement  force)  is  applied  for  the  first  time  (§47). 
In  the  treatise  on  Wounds  of  the  Head  (XXIX)  Hippocrates  says  that 
children  die  more  quickly  of  wounds  than  adults. 

In  the  treatise  on  Prorrhetics  (Littre,  IX,  52),  it  is  recognized 
that  prolapse  of  the  rectum  tnay  accompany  obstinate  diarrhea  or 
calculus  in  children.  For  treatment,  it  is  recommended  that  the 
rectum  be  replaced  with  soft  sponges,  the  child  being  suspended  with 
hands  tied;  or  in  obstinate  cases,  moisten  the  rectum  with  a sponge 
sopped  in  a decoction  of  lotus  ( Celtis  australis,  Littre),  compressing  the 
rectum  by  means  of  a bandage  passing  around  the  abdomen  and 
between  the  legs.  At  stool,  the  child  sits  with  its  back  against  its 
mother’s  knees,  its  feet  upon  her  feet.* 

In  his  commentary  on  the  treatise  De  morbis  {irtpi  vovauv),  Littre 
(VII,  25-161,  passim)  diagnoses: 

Cases  of  otitis  media,  otitic  abscess  of  the  brain,  tonsillitis,  inflammation  of  the 
tongue,  uvula,  epiglottis  and  palate,  removal  of  nasal  polypi  with  a string  snare  or 
by  cauterization,  jaundice,  bilious,  tertian  and  quartan  fevers,  pleurisy,  bron- 
chitis, abscess  of  lung  with  paracentesis,  phthisis  and  laryngeal  phthisis,  sper- 
matorrhea ( phthisis  dorsalis),  hydrothorax  with  paracentesis,  chronic  pneumonia, 
pulmonary  hemorrhage,  melena  (black  vomit),  tetanus,  ileus,  ischias  (coxalgia), 
dropsy,  hydatids,  hepatitis,  splenic  disease,  renal  tuberculosis,  rheumatic  disorders 
and  scurvy.  Any  of  these  may  have  affected  childhood. 

“Infantile  convulsions  supervene,”  says  Hippocrates,  “when 
there  is  acute  fever  or  constipation,  insomnia  or  sudden  fears,  or  when 
the  child  groans,  changes  color,  and  the  face  becomes  yellow,  livid,  or 
red.  These  accidents  easily  affect  infants  up  to  the  age  of  seven. 
Older  children  and  adults  are  less  exposed  to  convulsions  in  fever,  unless 
there  are  such  violent  and  fatal  complications  as  take  place  in  frenzy” 
(Prognostics  §24,  Littre,  II,  187).  In  the  discourse  on  the  Sacred 
Disease,  epilepsy,  which  the  ancients  regarded  as  due  to  divine  posses- 
sion, is  treated  as  a cerebral  affection  due  to  congestion  of  cold  mucus 
in  the  warm  blood,  unless  it  is  evacuated  by  ulcers  or  other  channels. 
Epilepsy,  then,  attacks  such  children  as  have  been  spared  the  affections 
which  would  relieve  them  of  the  slimy  material  commonly  voided  in 
uterine  life  (Littre,  XI,  367). 

* T.  Kroner:  Jahrb.  f.  Kinderheilk.,  Leipzig,  xi  (1877),  p.  256. 


HELLAS 


39 


If  it  is  fear  of  the  divinity  that  leads  adults  to  seek  seclusion  in  an  epileptic  fit, 
children  are  apparently  not  so  superstitious.  They  fall  where  they  stand,  or  if 
they  can  perceive  the  aura  from  the  experience  of  several  attacks,  they  run  in 
terror  to  their  mothers  or  to  some  one  they  know  {Ibid.,  383).  The  presence  or 
possibility  of  epilepsy  in  children  is  known  by  “sudden  distortion  of  the  eyes,  by 
tumors  on  the  neck,  or  when  a grave  accident  has  been  sustained  or  the  voice  is 
shrill,  or  there  is  chronic  cough,  or  lateral  distortion,  or  varix  of  internal  veins  or 
prolapsed  omentum,  or  an  enlarged  testicle  or  a helpless,  shrivelled  arm,  or  paraly- 
sis of  the  lower  limbs,  or  if  a more  mature  child  feels  bodily  pain  from  urethral 
discomfort.  Most  people  who  have  care  of  such  children  will  admit  epilepsy; 
others  deny  it  through  ignorance.” 

Ascarides  and  tenia  are  considered  in  the  treatise  De  morbis  (IV, 
54). 

Flat  and  round  worms  are  held  to  be  engendered  in  the  foetus.  Round  worms 
reproduce  themselves;  flat  worms  do  not.  Hippocrates  notes  the  great  increase 
in  size  of  the  taenia — “as  long  as  the  intestine  itself,”  in  which  case  parts  of  it  may 
be  voided  in  the  stools  or  even  in  walking.  If  the  child  is  purged  without  a vermi- 
fuge, this  will  bring  away  only  parts  of  the  worm.  The  worm  is  regarded  as  some- 
times impinging  against  the  liver,  causing  dribbling  of  saliva,  aphonia,  jerking 
sensations  in  the  abdomen  and  pain. 

Cystitis  is  treated  in  the  Prognostics  (19). 

Febrile  affections  of  the  bladder  may  cause  death,  if  they  persist;  there  is 
constipation,  or  the  voiding  of  hard  dejecta  on  purgation,  and  purulent  urine. 
If  the  fever  continues,  death  will  supervene  in  the  early  stages  of  the  disease, 
especially  in  children  from  7 to  15  years  of  age.  In  the  treatise  De  morbis  (IV,  55), 
there  is  a long  discourse  on  calculus  in  children,  to  which  Hippocrates  devoted 
particular  attention.  His  views  were  merely  repeated  by  the  later  authorities  and 
the  Middle  Ages  added  little  to  the  subject  (Kroner).  In  Hippocrates’  view,  lith- 
iasis  in  children  was  due  to  impure  milk.  The  greater  frequency  of  calculus  in 
boys  is  noted  (Kroner  says  that  40  per  cent,  of  all  cases  occur  in  children  under  ten, 
usually  boys).  Girls  are  less  affected  because  “they  drink  more  water  than  boys 
and  the  female  urethra  is  shorter  and  wider.”  The  observation  that  calculus  in 
boys  may  be  due  to  mother’s  milk  suggests  the  exudative  diathesis.  The  for- 
mation of  sediment  from  impure  urine  in  the  bladder  is  likened  to  the  settling  of 
sediment  in  turbid,  impure  water;  the  sediment  is  held  to  come  from  a mixture  of 
mucus  in  the  milk  with  the  urine.  The  five  signs  of  calculus  are  pain  in  urination; 
the  emission  of  urine  drop  by  drop;  bloody  urine,  if  the  bladder  is  ulcerated  by  the 
stone;  inflammation  of  the  bladder  with  reflex  pain  at  the  prepuce;  sometimes 
emission  of  sand  with  the  urine.  In  urinary  calculus,  male  infants  will  handle  and 
rub  the  genitals;  girls  do  not.  For  calculus  in  girls,  Hippocrates  prescribes  a 
drachm  of  the  leaf  of  Ethiopian  root  {Salvia  cethiops,  Littre)  in  old  urine  for  10 
days,  the  same  in  water  for  20  days  thereafter,  and  warm  baths  twice  daily. 

The  treatise  on  Airs,  Waters  and  Places  contains  a number  of 
valuable  pediatric  observations. 

In  places  which  are  warm,  moist  and  swampy  in  summer  and  cold  in  winter, 
children  will  suffer  from  respiratory  disorders,  convulsions  and  a tendency  to 
epilepsy.  In  places  with  changeable  weather  and  cold  winds,  nurslings  will  get 
little  mother’s  milk  on  account  of  the  hardness  of  the  wrater.  Hydrocele  is  fre- 
quent in  cold,  windy  places  and  disappears  in  children  as  they  grow.  Marshy, 
stagnant,  evil-smelling  waters  in  lakes  and  ponds  produce  large,  hard  (malarial) 
spleens,  stiff,  emaciated  bellies,  with  emaciation  of  the  face,  shoulders  and  clavicu- 
lar region;  also  fatal  dropsies,  diarrheas,  and  prolonged  quartan  fevers;  in  winter, 
there  are  dropsical,  wasted  children,  with  liability  to  hernia.  Pregnancy  in  wTarm, 
changeable  winters  or  in  springtime  with  cold,  northerly  winds  may  lead  to 
abortion  or  to  weak,  sickly  children.  The  late  advent  of  puberty  in  cold  climates 


40 


HISTORY  OF  PEDIATRICS 


is  noted,  also  the  tendency  of  Asiatics  to  deform  the  infantile  cranium  by  bandages 
and  machines. 

A few  of  the  Aphorisms  bearing  on  pediatrics  may  be  cited. 

“Elderly  people  bear  fasting  well;  infants  poorly,  especially  those  of  lively 
disposition”  (I,  13).  Galen  rightly  interprets  ‘‘fasting”  here  as  “spare  diet”: 

“The  growing  organism  has  the  most  innate  (animal)  heat  and  therefore 
requires  more  nourishment  (I,  14). 

“Liquid  diet  is  proper  in  all  febrile  diseases,  particularly  in  children  (I,  16). 

“Treat  epilepsy  in  the  young  by  change  of  air,  environment  and  mode  of  life 
(II,  45). 

“Children  bom  in  a mild,  calm,  rainy  winter  or  a cold  spring  are  apt  to  be  puny 
and  unhealthy  (III,  12). 

“Children  are  most  comfortable  and  healthy  in  spring  and  early  summer 
(III,  18). 

“The  diseases  of  new-born  infants  are  aphthae,  vomiting,  insomnia,  night  fears, 
inflammation  of  the  umbilicus,  and  discharges  from  the  ears  (III,  24). 

“At  teething,  there  are  pruritus  of  the  gums,  convulsions  and  diarrhea,  espe- 
cially when  cutting  the  canine  teeth,  and  in  fat,  constipated  infants  (III,  25). 

“A  little  later,  there  are  tonsillar  affections,  crick  in  the  neck,  asthma,  calculus, 
round  worms,  warts,  scrofula,  tumors  about  the  ears  and  elsewhere  (III,  26). 

“At  the  approach  of  puberty,  epistaxis  and  chronic  fevers  supervene  (III,  27). 

“Infantile  diseases  which  do  not  pass  away  at  puberty  become  chronic  (III,  27). 

“Difficult  deglutition  and  suffocation  in  fever,  without  swelling  of  the  neck, 
is  a fatal  symptom  (IV,  34-35). 

“Frights  or  convulsions  after  sleep  are  bad  symptoms;  stoppage  of  respiration 
in  fevers  indicates  convulsions  (IV,  67-68). 

“Epilepsy  before  puberty  may  change  for  the  better;  after  25  it  is  usually 
fatal  (V,  7).' 

“Rolling  of  the  eyes  in  sleep  is  bad,  unless  connected  with  loose  bowels  (VI,  52b 

“Acid  eructations  in  diarrhea  are  of  good  omen  (VI,  1). 

“Those  who  acquire  humped  backs  from  asthma  or  cough  before  pubertv  will 
die”  (VI,  46). 

With  Hippocrates,  Greek  pediatrics,  in  the  proper  sense  of  the 
term,  culminates  and  ends.*  After  the  destruction  of  Corinth  (146 
B.C.)  Greek  medicine  was  transplanted  to  Rome,  and  its  greatest 
representatives  in  Rome  came,  not  from  Athens,  Corinth  or  Thebes, 
but  from  the  peninsula  of  Asia  Minor, 


ROME 

From  Rome  came  the  first  laws  for  the  protection  of  children,  but 
there  was  to  be  a long  struggle  with  infanticide,  the  systematic  destruc- 
tion of  female  infants  and  the  inhumanities  of  the  patria  potestas. 
“The  Roman  policy,”  says  Lecky,  “was  always  to  encourage,  while 
the  Greek  policy  was  always  to  restrain  population,  and  infanticide 
never  appears  to  have  been  common  in  Rome  till  the  corrupt  and 
sensual  days  of  the  Empire.” f According  to  legendary  tradition, 
Romulus,  the  founder  of  Rome,  who  had  been  an  exposed  infant 

* For  a study  of  the  pediatrics  of  Hippocrates  as  compared  with  the  views  of 
modern  writers,  see  J.  W.  Troitzky : “Hippocrates  als  Kinderarzt,”  Arch.  f.  Ivinder- 
heilk.,  Stuttgart,  xxix  (1900),  pp.  223-247. 

f Lecky:  “History  of  European  Morals,”  New  York,  ii  (1869),  pp.  28-29. 


HOME 


41 


himself,  decreed  that  all  male  infants  who  were  not  monsters  or 
otherwise  malformed  were  to  be  reared,  as  also  the  first  born  of  all 
female  infants.  The  object  of  this  ruling  was  to  breed  a warlike  race, 
with  a superabundance  of  males  as  soldiers.  Even  the  Roman  census 
of  population  was  centered  on  estimating  the  fighting  strength  of  the 
nation.  To  Numa  Pompilius  (715-673  B.C.)  is  ascribed  the  law  cited 
in  Justinian  as  lex  regia  de  mortuo  inferendo,  which  decreed  that  a 
woman  who  had  died  in  pregnancy  should  not  be  buried  until  the  child 
had  been  excised  from  her  body,  lest  the  hope  of  the  living  perish  in  the 
grave.  From  the  “sombre  Puritanical  Sabine”  came  another  feature 
of  early  Roman  law  which  was  to  react  against  youthful  freedom  with 
frightful  force,  namely  that  part  of  the  Jus  Quiritium  which  made 
chattels  of  wives  and  children,  so  that  a father  could  sell,  mutilate  or 
even  kill  his  own  offspring  at  will  ( patria  potestas).  Numa  Pompilius, 
with  the  idea  of  encouraging  marriage  in  young  people,  amended  this 
hard  rule  to  the  extent  that  a father  lost  the  power  to  sell  his  son  when 
the  latter  obtained  consent  to  marry.  Under  the  Roman  Republic 
(509  B.C.)  the  patria  potestas  continued  in  full  force.  In  the  Laws  of 
the  Twelve  Tables  it  is  stated  that  a son  went  free  after  being  sold  three 
times  by  his  father.  The  exposure  of  infants  is  a common  dramatic 
motive  in  the  comedies  of  Plautus  and  Terence. 

In  the  best  days  of  the  Roman  Republic,  private  life,  particularly 
married  life,  was  sacred,  and  there  was  even  a tax  on  bachelors.  In 
the  last  days  of  the  Republic,  depravity  was  rampant  everywhere, 
celibacy,  divorce  and  abortion  were  frequent  and  unwelcome  children 
were  thrown  into  the  Tiber.  To  encourage  marriage  and  increase  the 
population  Augustus  Caesar  proposed  the  lex  Julia  (adopted  4 A.D.) 
and  the  lex  Papia,  which  put  a check  upon  the  abuses  of  the  patria 
potestas.*  Celibates  were  not  permitted  to  inherit,  and  a childless 
husband  could  inherit  only  one  half  of  property  or  of  moneys  willed  to 
him.  In  candidacy  for  office,  preference  was  given  to  the  father  of  the 
largest  family;  fathers  of  three  or  more  children  were  relieved  from 
taxes,  and  the  senior  of  the  two  consuls  was  held  to  be  he  who  had  the 
greater  number  of  children.  Anyone  who  reared  an  orphan  was 
rewarded.  Through  these  laws,  children  acquired  a new  importance 
by  conferring  rights  and  privileges  upon  the  father,  and  the  people,  as 
inheritors  of  the  childless  acquired,  in  the  phrase  of  Tacitus,  the  ficti- 
tious title  of  “universal  parent.”  Yet  the  great  historian  says  that, 
“to  enforce  this  regulation,  informers  were  encouraged.  The  genius 
of  these  men  knew  no  bounds:  they  harassed  the  city  of  Rome  and 
stretched  their  harpy-hands  all  over  Italy.  Wherever  they  found  a 
citizen,  they  found  a man  to  be  plundered.”  This  attempt  at  regulat- 
ing the  population  by  paternal  government  could  not  thrive.  Celibacy 
continued  popular,  and,  in  spite  of  subsequent  relief  from  espionage, 
these  laws  were  abolished  by  Caracalla  and  Constantine.  Gibbon 
begins  his  “Decline  and  Fall”  with  a memorable  eulogy  of  the 


Payne,  op.  tit.,  pp.  223-235. 


42 


HISTORY  OF  PEDIATRICS 


reigns  of  Nerva,  Trajan,  Hadrian  and  the  two  Antonines  as  the 
happiest  and  most  prosperous  period  in  all  Roman  history.  Payne 
calls  these  rulers  the  “emperors  of  the  children.”  In  the  reign  of 
Nerva,  there  was  an  attempt  to  diminish  the  exposure  and  drowning 
of  infants  by  founding  colonies  for  poor  families  and  assisting  indigent 
parents  (97  A.D.).  This  philanthropy  was  furthered  by  Trajan,  and 
in  100  A.D.,  some  5,000  children  were  cared  for  by  the  State. 
A Roman  coin  represents  Nerva  dispensing  charity  to  children  -with 
the  inscription  “Tutela  Italia.”  The  younger  Pliny  settled  500,000 
sesterces  on  the  city  of  Como  for  the  maintenance  of  children  of  good 
families,  and  a tablet  of  the  Ligurian  town  of  Velia  shows  that  the 
interest  on  land  mortgages  went  to  the  support  of  poor  children 
(Payne).  Hadrian  (117-138  A.D.)  decreed  that  the  child  of  a woman 
freed  during  pregnancy  should  be  free,  that  a woman  might  make  her 
will  and  that  a free  woman  could  inherit  if  she  had  children,  or  a freed 
woman  if  she  had  four,  and  that  Carthaginian  priests  were  to  be 
crucified  for  sacrificing  children  to  Moloch.  He  virtually  abolished  the 
patria  potestas  by  deporting  a father  who  had  killed  his  son,  and  by 
compelling  parents  to  rear  their  children  instead  of  exposing  them. 
The  mutilation  of  exposed  slave  children  in  order  to  make  them  objects 
of  charity  was  a great  abuse  of  the  time,  and  was  justified  by  the  philos- 
ophers as  better  than  letting  them  die.  But  laws  had  now  passed,  as 
a “Perpetual  Edict,”  into  the  hands  of  learned  jurists  and  could  no 
longer  be  changed  by  the  caprices  of  emperors.  Thus  Justinian  harks 
back  to  a rescript  of  Hadrian  declaring  the  sale  of  children  to  be  illicit 
and  dishonest.  Antoninus  Pius  (138-161  A.D.)  gave  to  children  the 
right  to  inherit  from  their  parents  and  founded,  in  honor  of  the  empress 
Faustina,  the  first  institution  for  the  protection  of  girls.  This  institu- 
tion, which  is  commemorated  in  a Roman  coin,  was  the  first  foundation 
designed  to  save  female  infants  from  destruction.  Other  endowments 
against  infanticide  grew  apace.  Marcus  Aurelius  (161-180  A.D.) 
abolished  the  paternal  power  of  compelling  the  son  to  divorce  his  wife, 
and  placed  the  alimentary  institution  of  Antoninus  Pius  under  the 
supervision  of  a praetorian  of  consular  rank.  These  great  benignant 
emperors  were  followed  by  a succession  of  bloody  tyrants.  Infanticide 
and  exposure  increased  as  poverty  increased.  Moved  by  the  pleadings 
of  Lactantius,  Constantine  issued  an  edict  to  all  Italy  and  Roman 
Africa  ordering  that  magistrates  give  immediate,  necessary,  and  suffi- 
cient aid  to  indigent  parents  (May  12,  315  A.D.),  and  in  order  to  save 
abandoned  infants  from  death  by  exposure,  declared  all  foundlings  to 
be  the  slaves  of  those  who  chose  to  rear  them,  punished  parents  who 
exposed  their  offspring,  and  gave  poor  parents  again  the  right  to  sell 
their  new-born  infants.  The  last  edict  bearing  upon  this  subject 
before  the  fall  of  the  Roman  Empire  was  that  of  Valentinian,  Valens 
and  Gracian,  punishing  a parent  for  the  exposure  of  his  children 
(Payne).* 


Payne,  op.  tit.,  pp.  236-256. 


GREEK  MEDICINE  IN  ROME 


43 


GREEK  MEDICINE  IN  ROME 

Of  the  Greek  physicians  after  Hippocrates,  those  who  are  to  our 
purpose — Aretseus,  Soranus  of  Ephesus  and  Galen — came,  not  from 
Athens,  Corinth  or  Thebes,  but  from  Asia  Minor.  The  only  Roman 
contribution  to  medicine  of  importance  is  Celsus,  which,  as  indicated 
by  the  researches  of  Max  Wellmann,  is  a compilation  or  translation 
from  many  Greek  sources,  in  particular  of  the  Greek  medical  handbook 
compiled  by  Cassius  Felix,  the  body  physician  to  Tiberius  Csesar 
{ante  26  A.D.). 

Celsus  says  that  children  are  healthiest  in  spring  and  early  summer,  young 
people  in  winter.  The  diseases  of  infancy  are  apthae,  vomiting,  night  vigils, 
discharges  from  the  ears  and  inflammation  about  the  umbilicus;  at  teething,  there 
are  ulcerations  of  the  canine  gums,  convulsions,  slight  fevers,  diarrhea,  particu- 
larly during  eruption  of  the  canine  teeth.  A little  later,  there  may  be  glandular 
tumors,  spinal  curvature,  struma,  and  painful  warts  (achordonas) ; at  puberty, 
lengthy  fevers  and  epistaxis.  All  children  are  in  greatest  danger  up  to  the  fortieth 
day,  or  in  the  seventh  month,  the  seventh  year,  or  at  puberty.  Infantile  diseases, 
therefore,  which  do  not  disappear  at  puberty  are  apt  to  continue  for  a long  time. 
Youth  is  most  exposed  to  acute  diseases,  epilepsy,  insanity  and  consumption, 
usually  with  haemoptysis.  A strong  point  made  by  Celsus  is  that  “ children  should 
not  he  treated  as  adults."  Venesection,  purgation  and  administration  of  wine 
should  be  avoided  in  weaklings,  and  care  should  be  taken  not  to  expose  the  child 
to  wakefulness,  hunger  or  thirst.  In  the  pestilential  fevers,  cupping  should  be 
employed  in  children  not  strong  enough  to  bear  venesection,  a light  diet  should  be 
given,  with  enemata  of  water  or  a decoction  of  pounded  barley.  The  anginas 
should  be  relieved  by  bloodletting,  purgation,  cupping  about  the  throat,  moist 
fomentations,  gargles  of  hyssop,  catmint,  thyme,  wormwood,  bran  or  dried  figs  in 
hydromel,  inunction  of  the  palate  with  ox-gall  or  powdering  it  with  pollen  of 
pepper;  finally,  free  incisions  may  be  made  at  need  under  the  mandibles,  in  the 
palate,  about  the  uvula  or  in  the  sublingual  veins.  Aphthae,  when  they  spread 
from  the  gums  to  the  palate,  uvula  and  fauces,  are  apt  to  kill  children.  When 
they  affect  sucklings,  the  nurse  should  exercise  her  body,  bathe  frequently  and 
foment  the  breasts  with  hot  water;  if  the  child  has  fever,  she  must  diet  and  drink 
plenty  of  water,  otherwise  light  wine;  she  must  purge  herself,  if  constipated,  or 
procure  emesis,  if  she  has  phlegm  in  her  throat.  The  ulcers  should  be  anointed 
with  honey  and  Syrian  rhus  (sumach),  or  bitter  almonds;  or  with  dry  rose  leaves, 
pine  kernels  and  small  mint  stalks  incorporated  with  honey;  or  with  mulberry 
juice  boiled  with  equal  parts  of  saffron,  myrrh,  alum,  wine  and  honey,  as  gargles. 
If  gargles  fail,  caustics  (alum,  chalcitis,  copper  sulphate)  may  be  used  with  light 
diet.  Cheese  and  honey  cleans  the  ulcers.  For  discharges  from  the  ears,  puncture 
with  a hot  needle  is  recommended  (VII,  8).  In  umbilical  hernia,*  avoid  operation 
and  employ  fasting,  purgation  or  an  application  of  a mixture  of  hemlock,  soot, 
washed  ceruse,  washed  lead,  two  eggs  and  the  juice  of  nightshade.  This  poultice 
should  be  kept  on  for  a considerable  while;  in  the  diet,  anything  causing  flatulence 
should  be  avoided.  In  infantile  hydrocele,  the  tumor  diminishes  during  fasting 
or  a slight  fever  (VII,  18).  In  infantile  hernia,  the  application  of  a bandage  will 
often  bring  about  reduction  without  recourse  to  the  knife  (VII,  20).  Operations  for 
phimosis  and  paraphimosis  are  described,  also  infibulation  in  boys  “for  preserving 
their  voices”  (VII,  25).  The  surgical  treatment  of  varicocele  ( ramex ) is  also  given 
(VII,  22). 

The  De  rerum natura  (I,  936-942)  of  Lucretius  (98-55  B.C.)  contains 
some  admirable  verses,  showing  how  the  Roman  physician  of  the  period 

* Hernia,  known  to  the  ancient  Romans  as  crepatura  and  ruptura,  was  first 
called  by  its  present  name  in  Martial  and  Arnobius  (Hyrtl). 


44 


HISTORY  OF  PEDIATRICS 


smeared  honey  around  the  rim  of  a bowl  to  disguise  the  taste  of  worm- 
wood administered  to  a child,  a device  which  was  doubtless  derived 
from  Greek  practice. 

In  the  treatise  on  acute  and  chronic  diseases  of  Aretaeus  the  Cap- 
padocian (2-3  Century  A.D.),  which,  according  to  Max  Wellmann, 
really  derives  from  Archigenes  (1st  Century  A.D.),  diphtheria  ( ulcera 
Syriaca  sive  Mgyptica) , pneumonia,  epilepsy,  cholera  infantum,  colic 
and  other  diseases  affecting  childhood  are  described  in  classic  style. 
Tetanus  in  children  is  mentioned  for  the  first  time. 

“Children  are  frequently  attacked  by  it,  but  do  not  often  die,  because  the 
affection  is  familiar  and  akin  to  them;  striplings  are  less  liable  to  suffer  from  it, 
but  more  readily  die.”  Children  usually  suffer  from  aphthae  until  puberty; 
“for  children,  in  particular,  have  large  and  cold  respiration,  there  is  more  heat  in 
them,  moreover  they  are  intemperate  in  diet,  have  a longing  for  varied  food  and 
cold  drink,  and  they  bawl  loudly  both  in  anger  and  sport;  and  these  diseases  are 
familiar  to  girls  until  they  have  their  menstrual  purgation.”  Cholera  attacks 
children  frequently,  but  is  not  usually  fatal.  Ileus  “is  common  in  children  who  are 
subject  to  indigestion  and  they  more  readiljr  escape  from  mischief,  owing  to  their 
habits  and  the  humidity  of  their  intestines,  for  they  are  loose.”  Children  with 
coughs,  even  youths,  are  apt  to  weather  phthisis.  In  the  3roung,  stone  usually 
form  in  the  bladder;  in  the  aged  in  the  kidneys.  Cachexia,  jaundice  and  swelling 
of  the  spleen  are  common  to  childhood  and  youth,  but  are  seldom  fatal.  “Children 
are  subject  to  continued  diarrhea,  from  an  ephemeral  intemperance  of  food,  but 
in  their  case,  the  disease  is  not  seated  in  the  cavity  of  the  stomach.  Diarrhea 
attacks  children  and  adolescents;  dysentery,  adults.  Children  are  also  subject 
to  anasarca  and  leucophlegmata.  The  bad  effects  of  gonorrhea  in  young  persons 
are  noted.”  Milk  is  the  best  remedy  for  marasmus  and  the  induction  of  vomiting 
is  beneficial  in  epilepsy. 

The  gynecological  treatise  of  Soranus  of  Ephesus  (2nd  Century, 
A.D.)  gives  the  most  remarkable  and  complete  account  of  pediatrics  in 
antiquity.*  It  consists  of  23  chapters  dealing  with  the  birth,  washing, 
swathing,  and  nutrition  of  the  infant,  the  choice  and  regimen  of 
the  nurse,  the  weaning  of  the  child,  teething,  tonsillitis,  aphthae, 
skin  eruptions  and  pruritus,  catarrh  and  coughing,  brain  fever  (menin- 
gitis?) and  diarrhea.  The  salient  characteristics  of  Soranus,  which 
set  him  quite  apart  as  a great  physician,  are  a highly  critical  spirit, 
rational  scepticism  and  scant  reverence  for  the  authority  of  the  past. 

If  tlie  new-born  child  is  fit  to  survive,  the  mother  must  have  been  strong  and 
healthy  during  pregnancy,  the  infant  should  cry  and  kick  vigorously  when  laid 
down  and  should  have  no  apparent  bodily  defects  or  abnormities.  The  cord 
should  be  severed,  preferably  with  a sharp  knife,  and  the  stump  ligated.  The 
Germanic  and  Scythian  custom  of  plunging  the  child  in  cold  water  after  omphalot- 
omy, in  order  to  harden  it  or  test  its  endurance,  is  strongly  condemned,  as  also 
washing  the  child  in  brine,  wine,  or  urine,  or  sprinkling  it  with  powder  of  myrtles 
or  nut  galls.  Even  exposure  to  the  air,  for  cooling,  is  bad.  Salting  the  child  is, 
however,  still  recommended.  The  crude  Thessalian  mode  of  swaddh'ng  recom- 
mended by  Antigenes  is  condemned,  and  a rational  routine  is  described  at  length, 
with  special  regard  to  gentleness  of  procedure.  The  barbarous  Thracian  and 
Macedonian  custom  of  binding  the  child  to  a hard  flat  board  is  to  be  avoided,  and  a 
wooded  pallet  or  a straw  mattress,  neither  too  hard  nor  too  soft  is  to  be  chosen, 

* For  a German  translation  of  which,  see  “ Die  Gynakologie  (irepl  ywaiKdcov) 
des  Soranus  von  Ephesus,”  iibersetzt  von  H.  Luneberg,  Munich,  J.  F.  Lehmann 
(1914),  pp.  56-92. 


GREEK  MEDICINE  IN  ROME 


45 


with  careful  attention  to  the  posture  of  the  child.  A clean,  moderately  warm 
room,  avoidance  of  draughts  and  excess  of  light,  and  a mosquito  netting  for  the 
infant’s  bed,  are  recommended.  If  the  child  shows  no  signs  of  hunger,  it  should 
receive  no  nourishment,  but  be  moved  about  continually  for  the  first  two  days. 
If  it  cries  for  food,  honey,  moderately  stewed,  is  preferable  to  indigestible  butter, 
abrotanum  with  butter,  nasturtium  or  barley  flour.  Mother’s  milk  is  held  to  be 
valueless  for  the  first  twenty  days,  as  being  thick,  cheesy  and  indigestible.  Honey, 
sometimes  mixed  with  goat’s  milk,  is  kept  up  for  the  first  three  days  (sugar  diar- 
rhea), and  the  mother’s  breast  must  first  be  sucked  by  another  infant  before  it  is 
given  to  the  new-born.  If  the  mother’s  milk  is  not  of  the  proper  consistency,  a 
professional  wet-nurse  is  to  be  preferred.  Soranus  actually  maintains  that  the 
mother  should  save  her  strength  for  future  childbearing  and  that  the  child  will 
thrive  better  on  the  milk  of  a stranger.  His  directions  for  the  choice  of  a wet-nurse, 
her  diet  and  mode  of  life,  the  testing  of  her  milk,  are  given  at  great  length  and  are 
similar  to  those  of  the  Indian  cult.  The  finger-nail  test  for  consistency  of  the 
milk— whether  it  spreads  gradually  over  the  nail  or  a laurel-leaf,  separating  into 
drops  on  shaking,  or  flows  thinly,  or  is  viscous — and  the  water  test,  its  preservation 
of  its  color  in  twice  the  amount  of  water,  are  here  specified  for  the  first  time. 
Multiparse  are  preferable  as  wet-nurses  to  primiparae,  on  account  of  the  inexperi- 
ence of  the  latter,  and  large,  robust,  matronly  nurses  to  small  or  attenuated. 
Greek  nurses  are  recommended  that  the  child  may  become  early  accustomed  to 
“the  most  beautiful  of  all  languages.”  Too  much  bathing,  and  bathing  in  hot 
water,  debilitates  the  child.  Bathing  should  be  done  in  the  day  time,  never  at 
night,  and  then  only  after  evacuation  of  the  bowels  or  for  skin  rashes.  The  water 
should  be  warm,  and  the  child  accustomed,  day  by  day,  to  colder  baths.  The 
directions  for  wiping,  rubbing,  salving  and  swathing  are  very  minute.  The 
subsequent  suckling  should  be  discreet  and  not  excessive;  the  child  must  not  be 
suckled  every  time  it  cries;  other  causes  than  hunger  should  be  sought,  if  it  cries 
continually.  The  child  should  not  be  rocked  or  otherwise  shaken  up  after  breast- 
feeding, as  the  effect  is  like  that  of  sea-sickness.  The  swaddling  clothes  may  be 
gradually  removed  in  40-60  days  after  birth.  If  the  child  tries  to  sit  up  or  stand, 
it  should  be  supported  to  avoid  deformation  of  the  spine  or  lower  limbs.  Soranus 
notes  that  these  matters  were  neglected  by  the  Roman  dames,  who  lacked  the 
warmth  of  sympathy  with  children  which  Greek  women  possessed.  Soranus’ 
observation  of  the  frequency  of  crooked  limbs  in  Roman  children  is  regarded  by 
Wilhelm  Ebstein  as  evidence  of  infantile  rickets  in  antiquity.*  The  child 
should  not  be  weaned,  for  any  reason,  until  it  is  strong  enough  to  take  solid  food, 
usually  not  less  than  six  months  after  birth.  Then  bread  crumbs,  softened  in 
honey-water,  milk,  sweet  wine  or  honey-wine  may  be  given.  Thereupon  a soup  of 
coarsely  ground  husked  wheat,  a thin  brew  and  soft-boiled  eggs  may  be  tried,  but 
no  milk  should  be  given  during  this  repast,  as  the  mixture  is  indigestible.  Thirst 
should  be  allayed  by  water  or  thinly  diluted  wine,  given  by  an  artificial  nipple. 
Nothing  to  be  chewed  should  be  given  at  first,  and  the  addition  of  roots,  poppy- 
seeds and  sesame  should  be  avoided.  Complete  weaning  should  come  to  pass  at 
the  eruption  of  the  teeth,  that  is  lJ^-2  years  after  birth.  Abrupt  weaning  by 
means  of  bitter  or  malodorous  applications  to  the  breasts  is  bad  for  the  infantile 
stomach.  Spring  is  the  best  time  for  weaning,  autumn  the  worst,  on  account  of  its 
uneven  temperature.  The  view  of  Mnesitheus  and  Aristanax  that  girls  should  be 
weaned  six  months  later  than  boys  is  condemned,  since  girls  are  not  weaker,  as 
these  writers  maintain,  but  of  stronger  and  fuller  habit  of  body  than  boys.  The 
child  must  be  early  accustomed  to  all  good  food  staples  after  weaning,  but  if  too  fat, 
its  diet  must  be  restricted,  and  if  it  is  gluttonous,  this  must  be  accomplished  by 
diverting  its  attention  with  play.  If  it  tends  to  reject  food,  its  appetite  must  be 
whetted  by  variety.  In  sickness  after  weaning,  milk  diet  must  be  resumed  until 

* W.  Ebstein.  Virchow’s  Arch.,  Berlin,  cxciii  (1908),  pp.  522-524.  Ebstein 
speaks  (p.  520)  of  an  infantile  skeleton  of  the  end  of  the  1st  Century  A.D.  (just 
before  Soranus),  excavated  at  Centirupe  and  now  in  the  Museum  at  Syracuse, 
showing  indubitable  signs  of  infantile  rickets. 


46 


HISTORY  OF  PEDIATRICS 


health  is  restored.  Teething  sets  in  about  the  seventh  month,  and  then  irritation 
of  the  gums  by  chewing  must  be  avoided.  Before  teething,  the  gums  should  be 
gently  rubbed  with  oil  or  fats,  and  the  child  may  be  permitted  to  suck  fat  bacon 
without  swallowing  it,  but  this  should  cease  when  the  teeth  appear.  The  gums 
should  not  be  irritated  by  butter  or  acid  substances,  and  if  there  is  much  inflamma- 
tion, poulticing  and  sponging  are  recommended.  In  tonsillitis,  honey  water  and 
barley  brew  may  be  introduced,  and  all  sources  of  congestion,  such  as  the  custom 
of  turning  the  child  upside  down  seven  times,  are  pernicious.  In  aphthae,  the 
mouth  may  be  anointed  with  honey,  in  mild  cases,  or  with  moist  astringent  applica- 
tions (lentils  and  pomegranates)  where  the  mouth  is  hot  and  dry;  internally,  fresh 
or  pressed  rose-leaves  or  Cyprus  or  tamarisks.  Mouth-washes  of  mulberries, 
poppies  and  plantains  in  honey,  iris  salves  with  honey,  or  any  astringent  decoction 
cooked  in  honey,  or  powders  of  rose-leaves,  saffron,  myrrh,  nut-galls,  juniper, 
moistened  with  honey,  or  any  of  these  mixtures  with  the  juice  of  sweet  pome- 
granates are  recommended.  Removal  of  the  scurf  with  the  finger,  a custom  of 
Syrian  nurses,  is  bad  practice.  Pruritus  is  treated  by  fomentations  and  applica- 
tions of  oily  salves,  with  a slight  admixture  of  wax,  that  they  may  cling  to  the  body; 
skin  rashes  and  ulcers  should  never  be  treated  with  salt  water  or  urine;  they  should 
be  let  alone  until  it  is  necessary  to  apply  decoctions  of  roses  or  lentils  or  astringent 
applications  of  myrtle,,  mastix,  blackberries  or  pomegranates,  etc.  Inflamed 
ulcers  after  evacuation  of  pus  are  treated  by  similar  applications.  Irritating 
remedies  are  to  be  avoided  in  catarrh  and  coughs;  honey  may  be  trickled  into  the 
mouth  or  the  phlegm  evacuated  by  inducing  vomiting;  in  attacks  of  coughing, 
dainties  such  as  pine-kernels,  roasted  almonds,  linseed,  licorice,  gouts’  thorn  and 
honey  are  best,  and  bathing  is  interdicted.  Siriasis,  an  inflammation  of  the  brain 
and  its  membranes,  with  sunken  fontanelles,  sunken  eyes,  pallor,  dryness  and  loss 
of  appetite,  is  treated  by  applying  to  the  temples  a mixture  of  rose  oil  and  yolk 
of  egg,  or  of  heliotrope  leaves,  pumpkin  chopped  fine,  cucumber  rind,  or  of  rose  oil 
and  nightshade  juice.  Infantile  diarrhea  is  treated  by  injecting  plantain  juice 
with  an  aural  syringe,  or  if  the  child  is  still  taking  the  breast,  by  giving  astringents 
to  the  nurse;  constipation  by  giving  laxatives  to  the  nurse.  If  the  child  has  been 
weaned,  the  same  remedies  may  be  given  directly.  Atresia  ani  is  remedied  by 
dilatation  with  the  finger  or  by  perforation. 

The  Nodes  Atticae  of  Aulus  Gellius  (2nd  century  A. D.),  known  to 
Latinists  as  a repository  of  curious  facts  about  antiquity,  contains 
some  striking  passages  about  the  care  of  infants,  in  which  the  ideas 
of  Soranus  about  breast-feeding  are  reflected. 

Galen  (131-201  A.D.)  gives  a long  series  of  controversies  on  the 
viability  of  the  seven-  and  eight-months  child,  with  much  admixture 
of  astrology;  opposes  the  German  and  Scythian  custom  of  immersing 
the  newborn  in  cold  water  for  purpose  of  hardening;  indulges  in  much 
casuistry  about  infant  nutrition,  warns  against  nursing  the  child  before 
its  bath  or  during  the  bath,  and  is  generally  at  one  with  Soranus  in 
regard  to  the  regimen  of  infant-life. 

He  mentions  congenital  atresia  of  the  urethra,  recommends  a plaster  bandage 
for  paraphimosis,  defines  hydrocele,  hermaphroditism,  hydrocephalus,  exomphalos 
(prominent  umbilicus),  epiploomphalos  (omental  prolapse  into  the  umbilicus), 
enteromphalos  (intestinal  prolapse)  and  hydromphalos  (water  in  the  umbilicus); 
gives  directions  for  the  physical  and  mental  regimen  of  epileptic  children ; describes 
white,  red  and  black  aphthae,  differentiates  between  round  worms,  ascarides,  and 
tenia,  and  recommends  verbena  ( heria ) and  helenium  for  ascarides;  he  mentions  the 
frequency  of  hiccough  in  children  and  ascribes  it  to  the  “corruption”  of  too  solid 
food  in  the  body  from  overeating  or  to  catching  cold;  he  defines  three  kinds  of 
intermittent  fevers,  viz.,  the  quotidian  (from  putrid  phlegm),  the  tertian  (from 
excess  of  yellow  bile),  and  quartan  (from  excess  of  black  bile)  and  regards  the 


BYZANTIUM 


47 


quotidian  as  peculiar  to  children.  He  describes  asthma,  in  connection  with  goitre, 
as  a painless  glandular  (thymus)  swelling  peculiar  to  the  neck.  In  his  treatise 
De  morborum  causis  (ed.  Kuhn,  1824,  VII,  27),  Galen  gives  an  account  of  infantile 
rickets.  * 

Caelius  Aurelianus  (5th  Century  A.D.)  is,  apart  from  Celsus, 
the  only  Roman  writer  who  contributed  anything  of  note  to  pediatrics. 

He  regards  epilepsy  as  a passio  puerilis,  frequently  associated  with  teething 
thus  confusing  it  with  infantile  convulsions.  For  treatment,  the  child  is  covered 
with  a cloth  and  warmed  by  rubbing  with  oil,  while  honey  is  sparingly  trickled  into 
its  mouth,  and  goat’s  milk  is  given  if  the  child  cannot  take  the  breast.  If  it  can 
suckle,  the  breast  is  smeared  with  honey.  ‘ The  child  should  be  carefully  guarded 
against  fright,  irritation  and  excitement,  and  if  the  nurse  is  epileptic,  she  must  be 
discharged.  He  describes  an  “ignis  sacer”  covering  the  neck  and  chest  in  inflam- 
matory angina,  which  was  probably  scarlatina  (Kroner).  He  gives  a good  account 
of  the  symptoms  of  intestinal  worms.  The  child  groans  in  its  sleep,  rolls  about, 
gnashes  its  teeth,  tends  to  lie  prone,  cries  out  suddenly,  or  falls  silent,  is  seized  with 
convulsions,  sometimes  becomes  somnolent,  the  face  becomes  emaciated  and  loses 
its  color;  the  child  gets  cold  and  answers  questions  noth  difficulty;  sometimes 
throws  itself  about  with  outstretched  hands,  working  itself  into  perspiration. 
The  worms  may  even  be  felt  in  the  thinnest  parts  of  the  intestines.  The  pulse,  as 
Themison  says,  is  irregular  and  often  deficient.  The  worms  sometimes  come  out  of 
the  nose  and  mouth,  as  well  as  the  rectum.  To  remove  them,  three  or  four  pills 
the  size  of  a bean  in  warm  water,  or  “chamelaeae”  rubbed  in  honey-wine  are 
recommended.  Asthma  is  described  as  a disease  peculiar  to  children  and  old 
people,  more  frequent  in  the  weak  than  in  the  strong,  occurring  oftener  at  night 
than  by  day,  in  winter  than  in  summer  with  a feeling  of  suffocation,  hissing  res- 
piration and  lividity  of  the  lips,  f 


BYZANTIUM 
(476-732  A.D.) 

The  role  of  Byzantium  in  the  history  of  medicine  was  that  of  an 
embalming  medium  or  cold  storage  plant  for  the  accumulated  knowl- 
edge of  the  past.  Byzantium  was,  in  Allbutt’s  phrase,  a citadel  of 
“culture,”  with  all  the  untoward  associations  which  have  latterly 
attached  to  the  term.  Church  and  State  were  supreme,  upheld  by 
laws  as  rigid  as  the  grip  of  a vice.  An  absolutist  theory  of  existence 
prevailed,  with  definite  aversion  to  freedom  of  thought  and  action. 
The  adjective  “Byzantine”  connotes  architecture  of  wonderfully 
massive,  ornate  type,  splendor  of  raiment,  decoration  and  creature 
comforts,  abounding  luxury,  licentiousness  and  with  it,  an  effemination 
or  eviration  of  character,  which,  in  the  end,  made  the  population  of 
the  great  city  powerless  to  protect  themselves  from  invasion.  People 
were  probably  no  worse  then  than  they  are  now  in  overcrowded 
communities,  but  their  life-lines  were  mapped  out  for  them  in  advance, 
and  virtue,  knowledge  and  talent  were  as  nothing  in  the  scale  with 
consistent  subservience  to  authority.  In  the  many  histories  of 

* Delpeuch,  Fresse  med.,  Paris  (1900),  p.  383.  W.  Ebstein,  Virchow’s 
Arch.,  Berlin,  cxciii  (1908),  pp.  524-528. 

f For  an  exhaustive  study  of  Greek  pediatrics,  arranged  by  diseases,  see 
T.  Kroner,  Jahrb.  f.  Kinderheilk.,  Leipzig,  N.  Y.,  x (1876),  p.  340;  xi  (1877), 
p.  83;  236. 


48 


HISTORY  OF  PEDIATRICS 


Byzantium,  we  hear  little  of  the  children,  except  that  “their  education 
tended  to  keep  them  all  in  a definite  groove”  (Finlay).  “In  place  of 
Augustus,”  says  Allbutt, 

“came  a kind  of  Sultan,  wearing  that  oriental  diadem,  the  mere  dread  of  which 
had  brought  Caesar  to  his  end;  the  Emperor  was  approached  with  adoration  as  a 
living  god,  and  lawyers  buttressed  his  throne  with  an  absolutist  theory  of  the 
constitution  which  was  universally  accepted ....  But  the  price  was  a heavy 
one;  the  heirlooms  of  the  past  were  carried  into  fortress,  and  for  a millenium  were 
immured  in  a sumptuous,  almost  a spellbound  treasure  house.  The  calcareous 
shell  was  of  mother  of  pearl;  the  walls  and  towers  of  the  casket  shone  in  the  sun 
with  such  splendor  as  Jeremy  Taylor  conceived  of  the  Kingdom  of  Heaven. 
Exalted  in  the  wilderness  of  Europe,  shining  like  a sun,  radiant  with  gold  and  gems, 
pompous  with  priests  and  men  of  war,  Byzantium  guarded  the  precious  germs 
of  which  a new  world  was  in  due  time  to  be  bom.  But  meanwhile  this  very  pomp 
which,  to  the  hordes  which  beset  it,  made  it  seem  invulnerable,  stiffened  the  sinews 
of  the  defenders.  In  their  serried  regiment  there  was  no  play  for  personal  freedom, 
no  play  for  varieties  of  temperament  or  diversities  of  creed.  A rigid  uniformity  of 
array,  an  absolute  subordination  of  rank  to  rank,  an  unbending  orthodoxy  of 
belief  were  the  cement  of  the  fortress,  the  conditions  of  its  solidity  and  immunity, 
and  the  protection  of  its  sacred  store.  We  shall  anticipate,  then,  that  within  its 
walls  there  would  be  no  expansion,  no  breathing  of  the  human  spirit,  but  the  immo- 
bility of  a great  rock,  the  silent  watch  of  its  sentinels,  the  enslavement  of  the  poor 
and  the  needy,  and  the  bondage  of  the  human  mind  . . . Heresies  were  per- 
secuted not  as  religious  but  as  political  perils.  Unfortunately  in  this,  as  in  too 
many  other  periods  in  the  world’s  history,  machinery,  when  it  has  served  its 
purpose,  is  not  scrapped  in  due  time,  but  endures  to  the  stifling  of  young  ideas  and 
the  bondage  of  young  limbs.”* 

The  Byzantine  Empire  lasted  until  1453,  surviving  even  the 
invention  of  printing,  but  it  never  attained  to  the  multiform  life 
of  the  later  Middle  Ages.  As  Hirschberg  says,  it  merely  went  on 
marking  time  in  the  past. 

Among  the  later  Greek  and  Roman  writers,  beginning  with  Galen 
and  Celsus,  there  had  arisen  a custom  which  was  to  be  the  fashion 
in  medical  literature  for  over  a thousand  years,  namely  the  attempt 
to  summarize  all  extant  medical  knowledge  into  one  massive  treatise. 
This  was  to  be  as  characteristic  of  Bartholomseus  Anglicus  as  of  Pliny, 
of  Niccolo  Falcucci  as  of  Galen  or  Avicenna.  Of  the  great  compilers  of 
Byzantium,  only  three  need  concern  us,  Oribasius  (325-403  A.D.), 
Aetius  of  Amida  (6th  Century,  A.D.)  and  Paul  of  iEgina  (625-690 
A.D.).  The  works  of  these  men  are  wonderful  and  even  fascinating 
summaries  of  the  medical  writings  of  antiquity.  Their  pediatric  lore 
is  considerable. 

Oribasius  (325-403  A.D.)  gives  Aristotle’s  lost  observations  on 
the  eight-month’s  child,  and  long  chapters  (Daremberg’s  Oribasius, 
III,  117-182)  on  the  rearing  of  infants,  the  choice  of  a nurse,  the 
quality  of  milk,  the  education  of  a child  up  to  14  and  after,  and  the 
regimen  of  childhood  according  to  Mnesitheus,  Rufus  of  Ephesus, 
Athenseus  and  Diodes. 

He  cites  the  recipe  of  Mnesitheus  for  “rheuma  of  the  brain”  (cold  in  the 
head) : Do  not  anoint  with  honey,  but  bathe  the  child  in  a warm  bath,  pouring  hot 

* Sir  T.  C.  Allbutt,  Byzantine  Medicine  (Finlayson  Lecture),  Glasgow  Med. 
Jour.,  lxxx  (1913),  4 s.,  p.  323. 


BYZANTIUM 


49 


water  on  its  head,  and  making  it  eat  much  honey;  then  induce  vomiting  by  tickling 
the  throat,  in  order  to  void  the  phlegm.  Meat  is  bad  for  infants,  also  thick  soups, 
as  creating  phlegm.  Honey  is  the  natural  first  food:  its  sweetness  is  attractive 
and  it  purges  the  intestines  of  meconium  (Rufus  of  Ephesus).  It  is  very  bad  for 
the  nurse  to  eat  celery,  mint,  or  garlic,  as  affecting  the  milk  and  inducing  epilepsy 
and  pustules  in  the  child.  Children  born  thin  are  apt  to  take  on  flesh  because 
they  need  it,  while  those  born  fat,  with  rosy  cheeks,  usually  get  thin  later,  because 
puffy  children  need  evacuation.  Never  frighten  infants,  as  it  may  lead  to  infantile 
convulsions  or  epilepsy.  Never  bleed  children  under  14.  Congenital  hypo- 
spadias, with  the  urethal  opening  in  the  lower  surface,  also  epispadias,  are  de- 
scribed at  length,  with  surgical  treatment.  Antyllus’  account  of  phimosis,  para- 
phimosis, and  dislocated  phimosis  is  preserved  in  Oribasius.  Three  varieties  of 
hydrocephalus  (between  the  skin  and  pericranium,  between  pericranium  and 
cranium,  between  cranium  and  the  cerebral  membranes)  are  described  in  great 
detail.  The  observations  of  Galen  and  Archigenes  on  white,  red  and  black  aphthae 
and  their  frequency  in  Egypt  recur  in  the  Byzantine  compilation,  and  erysipelas 
is  again  mentioned.  Skin  eruptions  from  perspiration  and  other,  causes  are 
enumerated  among  children’s  diseases  and  are  also  ascribed  to  unwholesome  milk 
or  contagion  from  the  maternal  parts  at  birth.  Diaphoretic  remedies  are  pre- 
scribed for  the  wet-nurse.  The  directions  for  the  education  of  children  in  Oribasius 
are  refreshingly  modern  in  spirit.  In  the  seventh  or  eighth  year  boys  and  girls 
should  be  confined  to  genial,  humane  tutors,  whose  encouraging  praise  and  pleasant 
flow  of  language  will  inspire  them  to  excel.  A generous  diet,  too,  must  not  be  for- 
gotten (mddern  school-lunches  for  children).  Bitterly  censorious  teachers  who 
obstinately  uphold  their  authority  everywhere,  will  only  make  slavish,  cringing, 
fearful  pupils,  disgusting  them  with  the  objects  of  instruction.  How  can  it  be  other- 
wise, he  says,  when  the  child,  which  loses  its  presence  of  mind  when  beaten,  is  yet 
required  to  learn  and  memorize  what  it  learns?  Children  who  are  tormented  with 
instruction  all  day,  and  not  allowed  to  play,  are  in  exactly  the  same  class  with 
servants,  who  break  down  from  unintermitting  labor  without  recreation.  At 
twelve,  languages  and  the  mathematics  should  be  begun,  with  bodily  exercise  under 
experienced  instructors,  who  know  the  right  measure  and  the  right  time  for  eating, 
gymnastics,  bathing  and  sleep.  Most  people  will  engage  thoughtful  or  experi- 
enced men  to  look  after  their  stables,  at  a liberal  salary,  while  they  entrust  their 
children  to  inexperienced  teachers,  usually  ignorant  persons  who  have  already 
failed  in  life. 

There  is  much  sound  pediatrics  in  the  huge  “Tetrabiblion”  of 
Aetius  of  Amida,  who  was  royal  physician  to  Justinian  I (527-565 
A.D.)  and  lord  high  chamberlain  at  the  Byzantine  Court. 

Lingual  adhesion  is  described  as  a common  abnormity,  with  semeiology;  the 
acquired  form  is  usually  due  to  hard  sublingual  ulcers  and  cicatrices.  Movement 
of  the  tongue  and  sucking  the  breast  are  difficult,  speech  comes  late,  and  words 
containing  the  letters  R,  L and  K are  difficult  to  pronounce.  An  operation  for 
severing  the  frenulum  is  given.  Ranula  ( ranunculus ) is  described  as  a sublingual 
tumor,  usually  affecting  the  veins.  Acquired  umbilical  hernia,  from  distension 
of  the  abdomen  by  faulty  diet  and  flatulent  colic,  is  clearly  recognized.  The 
symptoms  of  tonsillitis  are:  marked  fever,  difficult  swallowing,  constipation, 
increase  of  pain  in  the  evening,  pain  in  the  ears,  difficult  breathing.  Gargles, 
liquid  and  semi-solid  foods  and  blood-letting  are  prescribed,  and,  if  there  is  sup-, 
puration,  an  Egyptian  salve  of  resin  with  turpentine,  honey  and  sweet  oil.  There 
is  some  evidence  that  Aetius  knew  of  the  scarlatinal  anginas.  Incontinence  of 
urine  is  differentiated  as  either  continual  and  dribbling  or  occasional  and  noc- 
turnal. The  former  is  attributed  to  paralysis  of  the  sphincter  of  the  bladder. 
Drinking  water  in  the  evening  and  irritating  applications  to  the  parts  are  forbidden. 
Hiccough,  from  hasty  suckling  or  from  cold  by  wetting  the  clothes,  is  treated  by 
caraway  seed,  acidum  scyllinium,  holding  the  breath,  production  of  sneezing, 
elevating  the  extremities  and  bringing  them  together,  and  cold.  Otitis  is  treated 
Vol.  1—4 


50 


HISTORY  OF  PEDIATRICS 


by  trickling  in  albumen  mixed  with  human  milk;  aural  discharges  by  irrigating 
the  ear  with  alum  and  wine  and  plugging  it  with  soft  wool.  Eczemata  are  defined 
as  painful,  non-purulent  pustules,  resulting  from  heat  and  perspiration.  Herpes 
is  ascribed  to  accumulation  of  yellow  bile  in  the  locality  affected.  If  it  collects 
in  quantity  with  ulceration  of  the  whole  skin,  it  is  “herpes  exedens.” 

Alexander  Trallianus  (525-606)  left  a treatise  on  intestinal  worms, 
which  was  translated  into  Latin  by  Hieronymus  Mercurialis  (Venice, 
1570)  and  subsequently  incorporated  in  his  pediatric  treatise  (1583). 

Paul  of  TEgina  (625-690),  the  last  of  the  great  Byzantine  compilers, 
begins  his  Epitome  with  a series  of  compact  chapters  on  the  complaints 
of  pregnancy,  the  wet-nurse,  the  milk,  how  to  correct  bad  qualities 
of  milk,  the  management  of  infancy,  infantile  eruptions,  cough  and 
defluxion,  pruritus,  dentition,  aphthae,  excoriations  of  the  thighs, 
discharges  from  the  ears,  siriasis,  the  regimen  of  childhood  and  youth, 
exercise,  the  kinds  of  friction,  vociferation  or  exercise  of  the  voice, 
constriction  of  the  skin  and  lassitude.  Whoever  wishes  to  gain  a 
bird’s  eye  view  of  pediatrics  from  classical  antiquity  to  the  late  Renais- 
sance period,  will  do  well  to  read  these  terse  chapters  in  the  English 
version  of  Francis  Adams  of  Banchory,  with  his  scholarly  and  illumi- 
nating commentaries.  Much  of  the  Pauline  pediatrics  is  taken  from 
Oribasius,  going  back  from  Oribasius  to  Galen,  Soranus,  and  their 
predecessors,  while  the  same  material  was  copied  and  carried  forward 
in  a monotonous,  almost  mechanical,  way  by  Rhazes,  Haly  Abbas, 
Avicenna,  Bagellardo,  Metlinger  and  the  later  Renaissance  writers. 
Oribasius  and  Paul  are,  in  fact,  half-way  houses  between  remote 
antiquity  and  such  pediatrists  of  newer  stamp,  as  Walter  Harris  or 
Underwood.  The  old  thumb-nail  and  rennet  tests  for  nurses’  milk, 
for  instance,  which  originated  with  Soranus,  were  passed  on  by  Ori- 
basius and  Paul  to  author  after  author,  long  after  Soranus  and  the 
Byzantines,  who  cribbed  his  material,  had  been  forgotten.  The 
vegetable  remedies  for  infantile  disorders  proposed  by  Oribasius  and 
Paul  were  enormously  multiplied,  for  each  disease,  by  the  drug-fancies 
of  the  Arabian  physicians. 

Paul  describes  ranula  (ranunculus)  as  an  inflammatory  sub-lingual  tumor, 
usually  occurring  in  childhood  (III,  26).  To  Soranus’  treatment  of  imperforate 
anus,  he  adds  excision  of  the  occluding  membrane  with  the  scalpel,  irrigating  the 
wound  with  wine  (a  common  procedure  in  the  mediaeval  treatment  of  wounds). 
Atresia  of  the  pudenda,  atresia  vaginae  and  imperforate  hymen  are  clearly  differ- 
entiated (VI,  72),  with  directions  for  exploration  with  an  instrument,  incision  or 
excision  with  a fistula-scalpel,  and  plugging  of  the  vagina  with  a tent  of  charpie. 
Three  kinds  of  hermaphrodism  (after  Leonides)  are  noted  in  males,  and  one  in 
females  (IX,  69).  In  the  extensive  chapter  on  ophthalmology,  congenital  strabis- 
mus is  described  for  the  first  time  as  a spasmodic  affection  of  the  muscles  moving 
"the  eye  (III,  22).  The  squint  is  remedied  by  a visor-mask,  compelling  the  child  to 
look  straight  forward.  This  was  afterward  figured  in  the  illustrated  ophthalmolog- 
ical  treatise  of  George  Bartisch  (Dresden,  1583).  A lamp  is  placed  opposite  the 
mask,  so  as  not  to  shine  obliquely;  then  the  eye  is  turned  to  the  nose;  purple 
flocks  of  wool  should  be  fastened  to  the  outer  angle  of  one  eye,  so  that  by  looking 
at  them  steadily,  the  patients  may  correct  the  state  of  vision.”  Eczemata  and 
impetigo  in  children  are  mentioned  (IV,  3)  and  an  attempt  is  made  to  differentiate 
between  the  splotches  of  leprosy  and  those  of  psoriasis. 


ISLAM 


51 


In  the  Byzantine  Period,  the  early  Fathers  of  the  Christian  Church 
concerned  themselves  not  a little  with  medicine.  Tertullian  surpassed 
all  others  in  his  scientific  and  medical  knowledge.  (Harnack). 

In  support  of  the  Christian  doctrine  that  even  the  unborn  child  is  endowed  with 
a soul,  he  speaks  of  the  “unconscious  intelligence”  of  climbing  plants,  and  main- 
tains that  even  the  crying  of  the  child  shows  its  consciousness  of  birth  into  life. 
“It  recognizes  mother,  nurse  and  wet-nurse  by  their  breasts,  rejects  an  unfamiliar 
breast,  dislikes  a strange  bed,  and  will  only  go  to  persons  whom  it  knows.”  Devel- 
opment depends  upon  environment  and  education.  Dull,  stupid  people  come  out 
of  Thebes,  the  Athenians  are  the  cleverest  in  thought  and  speech,  and  in  the  pre- 
cinct of  Colyttus,  where  Plato  was  born,  children  learn  to  speak  a month  earlier 
than  is  usual.  The  soul  originates  with  generation  of  the  foetal  body,  as  preg- 
nant women  know,  for  still-born  children  are  evidence  that  life  was  once  in  them. 
In  this  doctrine,  the  soul  is  actually  generated  at  impregnation  and  unfolds  itself 
at  puberty,  an  argument  which  was  the  mainstay  of  Christian  antagonism  to 
abortion  and  infanticide.  Craniotomy  and  dismemberment  of  the  fetus  to  save 
the  mother’s  life  are  attacked  for  the  first  time  in  the  writings  of  Tertullian. 
Eusebius  (302  A.D.),  Gregory  of  Tours  (581)  and  Marius,  Bishop  of  Avenehes 
(570)  described  epidemics  of  small-pox,  which  was  first  called  variola  by  Marius. 
Diphtheria  is  called  “ esquinancie”  ( cynanche ) in  the  Chronicle  of  St.  Denis  (580), 
and  Roman  epidemics  of  856  and  1004  were  described  by  Baronius,  and,  in  Byzan- 
tium (1039)  by  Cedrenus.  In  the  5th  century,  A.D.,  the  German  barbarians 
designated  crooked  limbs  as  “krump,”  and  humped  backs  as  “hover;”  the  Anglo- 
Saxons  called  the  rhachitic  pigeon-breast  “the  sharp  bone”  ( scearpan  banum)  and 
the  narrow  chest  “ angbreast”  (Heyne;  Hofler).* 

ISLAM 

(732-1096  A.D.) 

In  the  Byzantine  civilization,  we  see  a rigid  scheme  of  political 
dogma  imposed  upon  an  isolated  community  for  an  extraordinary 
period  of  time.  In  the  Mohammedan  world,  we  see  the  same  thing 
distributed  down  to  the  present  time  over  the  widest  area  of  space. 
Whether  in  Egypt  or  India,  Bosnia  or  Persia,  Islam  remains  the  same. 
Fatalism  and  resigned  submission  to  authority  characterize  the 
Mohammedan  faith,  and  like  the  Greeks  and  the  Romans  in  classical 
antiquity,  the  Moslem  sees  epidemic  diseases  as  scourges  of  God  and  is 
ignorant  of  the  fact  of  contagion.  A rigid  conservatism  prevented 
him  from  grasping  the  larger  problems  of  public  hygiene,  and  what 
progress  he  made  in  the  sanitation  of  private  life  was  due  to  the 
wise  teachings  of  the  Prophet,  and  to  the  native  ingenuity  of  the 
Moslem  chemists  and  craftsmen.  To  Mohammed  was  due  the  inter- 
diction of  female  infanticide  (Koran,  XVI,  60-61)  and  the  state  care 
of  foundlings.  The  pagan  Arabs  of  the  pre-Islamitic  period  buried 
their  daughters  alive. 

The  Koran f prescribes  that  mothers  shall  suckle  their  children  for  two  full 
years  (II,  233),  or  that  the  total  period  of  pregnancy  and  lactation  up  to  weaning 

* Moriz  Heyne:  “ Korperpflege  und  Kleider  bei  den  Deutschen  von  den  altesten 
geschichtlichen  Zeiten,  etc..,  Leipzig  (1903),  p.  22.  M.  Hofler,  Altgermanische 
Heilkunde  (Puschmann,  Handbuch  der  Geschichte  der  Medizin,  Jena,  i (1902), 
p.  476).  Cited  by  W.  Ebstein,  op.  tit.,  pp.  528-529. 

t See  T.  P.  Hughes,  “A  Dictionary  of  Islam.”  London  (1885),  pp.  50-53. 


52 


HISTORY  OF  PEDIATRICS 


shall  be  thirty  months  (XLVI,  14).  If  the  mother  is  unable  to  suckle  her  child  a 
wet-nurse  may  be  employed  (LXV,  6).  In  the  Koran,  the  stratagem  mentioned 
in  Exodus  (II,  1-9),  whereby  the  aunt  of  Moses  secured  his  mother  as  a wet-nurse, 
has  the  variant  that  Egyptian  wet-nurses  were  first  offered  and  rejected  (XXVIII, 
11),  which  Opitz  interprets  as  meaning  that  Mohammed  believed  that  maternal 
milk  strengthens  the  racial  characteristics  in  a child.  These  are  the  only  pediatric 
items  in  the  Koran,  a book  in  which  honey  is  specified  as  the  sole  and  universal 
human  remedy  (XVI,  71).*  The  rest  of  Arabic  custom  in  regard  to  the  care  of 
infancy  is  preserved  in  the  Mohammedan  books  of  ethics  as  handed  down  by 
tradition.  At  birth,  the  child  is  washed,  swathed  and  carried  by  the  chief  malaivi 
to  a gathering  of  male  relatives  who  chant  the  azan  and  the  iquamah  (calls  to 
prayer)  in  the  child’s  left  ear,  as  the  Prophet  is  said  to  have  done  to  his  grandson 
Hassan.  Following  another  action  of  Mohammed’s,  the  malaivi  then  chews  a bit 
of  date-fruit  and  puts  it  in  the  child’s  mouth.  Alms  are  then  distributed,  in 
weight  equal  to  the  weight  of  the  infant’s  hair,  shorn  for  this  purpose,  and  verses 
from  the  first  chapter  of  the  Koran  are  recited  for  the  health  and  prosperity  of  the 
child.  The  friends  and  neighbors  then  visit  the  home  with  presents  and  con- 
gratulations. The  infant  is  named  on  the  seventh  day,  usually  after  the  Prophet, 
his  followers  or  relatives,  or  some  member  of  the  child’s  family.  On  the  same  day 
is  observed  Mohammed’s  ceremony  of  the  aqiqah,  that  is  the  sacrifice  to  God  in  the 
name  of  the  child  of  two  young  unblemished  he-goats  in  the  case  of  a boy,  or  one 
he-goat  for  a girl.  The  animals  are -dressed  and  cooked,  and,  as  the  friends  par- 
take, they  pray  as  follows: 

“O  God!  I offer  to  thee,  instead  of  mine  own  offspring,  life  for  life,  blood  for 
blood,  head  for  head,  bone  for  bone,  hair  for  hair,  skin  for  skin,  in  the  name  of  the 
great  God,  I do  sacrifice  this  goat.” 

This  ritual  of  substituting  a scapegoat  for  the  sacrifice  of  the  child  itself  is 
enjoined  by  Mohammedan  law  and  observed  in  all  parts  of  Islam.  On  the  fortieth 
day,  the  mother  is  purified  and  is  then  free  to  go  about  as  usual.  On  this  day  the 
child  is  placed  in  a swinging  cradle.  If  a wet-nurse  is  employed,  she  must  be  a 
woman  of  well-balanced  temperament,  since  her  traits  are  apt  to  be  communi- 
cated to  the  child.  As  soon  as  a boy  can  talk,  he  is  taught  the  opening  phrase  of 
the  Koran  ( Bismillah ).  He  is  then  sent  to  school  to  learn  the  alphabet  and  to 
recite  certain  chapters  of  the  Koran.  The  memorizing  of  the  whole  of  the  Koran 
completes  his  religious  education.  To  this  are  added  the  ordinary  rules  of  arith- 
metic. Schools  are  very  numerous  in  the  Mohammedan  world.  Sir  Richard 
Burton  said  that  “Islam  orders  a school  to  be  built  by  whoever  erects  a mosque.” 
Circumcision  ( khitan ) is  not  mentioned  anywhere  in  the  Koran,  but  it  is  held  to  be 
sunnah  (necessary  and  proper),  and  according  to  the  tradition  of  the  Prophet, 
who  was  assumed  to  have  been  circumcised.  It  is  usually  done  in  the  seventh  year, 
but  it  is  lawful  that  it  be  done  on  the  seventh  day  after  birth  or  at  any  time  between 
the  seventh  and  twelfth  years.  The  rite  is  usually  performed  by  a barber  and 
consists  in  drawing  the  prepuce  tightly  forward  with  a bamboo  forceps,  causing 
great  momentary  pain,  which  is  swiftly  terminated  by  a brisk  downward  stroke  of 
the  knife.  The  hemorrhage  is  checked  with  burnt  rags  and  ashes.  In  Egypt,  the 
rite  is  preceded  by  an  elaborate  street-parade  and  ceremonial  (Lane).  Puberty 
is  established  by  the  inception  of  virility  and  menstruation,  and  is  declarable  at 
15  in  both  sexes.  The  Mohammedan  theory  of  life  is  that  a boy  should  be  edu- 
cated as  soon  as  he  is  weaned,  taught  gravity  and  decorum  by  extreme  respect  for 
his  parents  and  the  society  of  his  elders,  inured  to  hardship  and  contempt  for 
luxury,  set  to  employment  he  is  best  qualified  for  (vocational  aptitude  being 
often  determined  by  horoscope),  and  married  as  soon  as  he  is  established  in  the 
world.  The  training  is  stoical,  designed  to  make  warrior-gentlemen.  The  only 
objects  of  food,  worldly  possessions,  sleep,  etc.,  are  the  maintenance  of  health. 
Food  and  drink  are  held  to  be  medicine  for  the  cure  of  hunger  and  thirst  and  are 
to  be  as  sparingly  used  as  drugs.  Delicacies  and  a varied  diet  are  scorned.  Sub- 
sistence upon  a single  dish  or  upon  dry  bread  is  held  to  fit  a man  for  hard  times. 

* Iv.  Opitz,  “Die  Medizin  im  Koran.”  Stuttgart  (1906),  pp.  15-16. 


ISLAM 


53 


Little  meat  is  eaten  and  liquids  are  not  drunk  at  table.  Physical  hardening 
is  attained  by  intensive  exercise.  To  sleep  by  day  is  despicable.  Strong  drink, 
sweetmeats  and  unusual  creature  comforts  are  forbidden.  Wealth  and  luxury 
are  despised  as  diminishing  the  capacity  to  endure  the  desert,  if  necessary.  The 
attainment  of  an  elegant  dignified  style  of  manners  is  a worthy  ambition.  Actions 
are  open  and  above  board,  lest  they  be  culpable,  and  a child  is  trained  to  silence. 
The  seven  deadly  sins  of  Islam  are  “disobedience  to  parents,  idolatry,  murder, 
falsely  accusing  modest  women  of  adultery,  wasting  the  property  of  orphans, 
usury,  and  desertion  of  an  expedition  against  infidels.”  The  grave  decorous 
attitude  of  the  boy  toward  his  parents  fits  him,  as  Lane  says,  for  an  abrupt  intro- 
duction into  the  world,  and  for  society.*  Sir  Richard  Burton, f however,  found 
the  children  at  Medina,  like  the  enfants  terribles  of  India,  “a  nursery  of  madlings, 
pulling  to  pieces  everything  they  could  lay  their  hands  upon,  and  using  language 
that  would  have  alarmed  an  old  man-of-war’s-man.”  He  says  that  “parents 
and  full-grown  men  amuse  themselves  with  grossly  abusing  children,  almost  as 
soon  as  they  can  speak,  in  order  to  excite  their  rage  and  to  judge  of  their  disposi- 
tions.” The  object  is  to  temper  them  for  life.  Punishments  are  often  in  the 
nature  of  tongue-lashing,  and,  in  corporal  punishment,  blows  are  short,  sharp, 
decisive  and  few  in  number,  lest  punishment  lose  its  power.  Girls  do  not  learn 
to  read  or  write,  but  are  brought  up  in  rigid  seclusion  and  taught  only  domestic 
matters.  Burton,  in  his  “Notes  on  Waitz’s  Anthropology,”  says  of  the  Oriental 
policy  of  seclusion:  “The  Muslimah  is  certainly  guarded  from  temptation;  and 
when  she  falls  into  it  she  is  deservedly  punished.  The  Christian  woman  is 
exposed  to  every  risk,  and  placed  upon  a comfortless  eminence,  that  publicity 
may  deter  her  from  yielding.  Although  the  tales  of  Aladdin  and  Sinbad 
have  delighted  the  children  of  civilized  humanity  for  centuries,  the  entire  Arabian 
Nights  contain  only  two  references  bearing  upon  our  subject,  viz.,  that  Arab  infants 
are  commonly  carried  astride  the  nurse’s  hip  or  shoulder  and  that  the  expres- 
sion “child  of  the  nurse”  implies  that  an  individual  has  been  delicately  reared 
(Burton). 

The  pediatric  literature  of  Islam  is  meagre  and  far  inferior  to  that 
of  Byzantium.  Rhazes,  Avicenna  and  Haly  Abbas,  in  fact,  took 
much  of  their  pediatrics  from  Oribasius  and  Paul  of  dEgina. 
Appended  to  the  ten  books  of  Rhazes  (869-962)  “ ad  Almansorem”  is 
a brief  pediatric  treatise  (De  cegritundinibus  puerorum  et  earum  cura ) 
in  24  chapters,  each  descriptive  of  a separate,  disease.  This  treatise 
was  liberally  copied  by  Avicenna,  Bagellardo  and  the  subsequent 
authors. 

The  chapters  deal  with  an  impetigo-like  head  eruption  ( sahafati ),  a favus 
variety  of  the  same  (Javositas  puerorum),  hydrocephalus,  tympanites  (inflated 
abdomen),  sneezing  (coryza),  wakefulness,  epilepsy,  indigestion,  aural  discharges, 
purulent  otitis  {de  veneno  fluente  de  auro ),  diseases  of  the  eyes  (conjunctivitis), 
infantile  strabismus  {de  obliquitate  visus),  disease  of  the  teeth,  aphthas,  vomiting, 
diarrhea,  constipation,  cough,  pruritus  and  rashes,  intestinal  worms,  umbilical 
hernia,  fissure  {de  crepatura),  vesical  calculus,  and  relaxation  and  spasticity  of  the 
limbs  and  body  {siphac).§  The  merit  which  these  individual  chapters  possess 
over  other  clinical  paragraphs  of  the  same  kind,  for  a long  time  before  and  after, 

* Lane,  Modern  Egyptians. 

t Sir  R.  F.  Burton,  “Pilgrimage  to  Al-Medinah  and  Meccah,”  London,  ii  (1893), 
pp.  292-293. 

t Burton:  Anthrop.  Rev.,  London,  ii  (1864),  p.  249. 

§ Siphac,  according  to  Hyrtl,  is  a generic  term  for  membrane  or  skin.  Rhazes’ 
definition  of  “relaxation”  reads  like  a foreshadowing  of  infantile  paralysis:  “Relax- 
atio  accidit  pueris  vel  in  uno  membro  vel  toto  corpore  et  prohibet  ipsum  ab  ambula- 
tione  et  motu;  provenit  propter  viscosum  humorem  relaxantem  nervos”  (Cap. 
XXIV). 


54 


HISTORY  OF  PEDIATRICS 


is  that  the  semeiology  of  each  disorder  is  clearly  stated,  as  far  as  the  author’s 
knowledge  goes,  that  where  etiological  reasoning  is  attempted,  a simple  common- 
sense  cause  (such  as  corruptio  lactis)  is  assigned,  with  little  reference  to  humoralism. 
The  treatment,  while  mainly  herbal,  is  usually  plain  and  simple  with  a little  touch 
of  superstition  here  and  there.  Rhazes  notes  the  yellow  stools  and  griping  pains 
in  infantile  diarrhea  ( albedo  in  egestione  et  tortio  in  ventre),  and  recommends  the 
application  of  an  emplastrum  constipans  to  the  abdomen.  For  insomnia,  oil  of 
violets  in  vinegar  or  oleum  anetinum  with  lettuce  juice  are  put  in  the  child’s 
nostrils,  and,  of  course,  it  is  allowed  to  suck  syrup  of  poppies,  while  the  temples  and 
forehead  are  bathed  with  oil  of  opium  and  crocus.  In  epilepsy,  the  diet  is  to  be 
regulated,  the  nurse  purged;  the  child  is  given  only  what  milk  it  can  digest; 
it  is  given  asafoetida  to  smell,  and  (a  remnant  of  the  cult  of  Apollo)  a peony  is  sus- 
pended around  its  neck  and  an  emerald  attached  to  its  feet.  Poppies,  among 
other  simples,  are  exhibited  in  cough.  In  vesical  calculus,  the  strangury,  ten- 
uous stream  of  urine,  great  pain  and  penile  pruritus  are  noted.  The  prescrip- 
tions for  syrups,  electuaries,  plasters,  etc.,  are  written  in  modern  style,  with  the 
Arabic  symbols. 

The  treatise  on  smallpox  and  measles  of  Rhazes,  translated  into 
English  by  W.  A.  Greenhill  (1848),  is  perhaps  the  most  remarkable 
contribution  to  internal  medicine  between  Hippocrates  and  Sydenham. 

After  making  the  usual  obeisance  to  Galen,  who  has  vague  references  to  small- 
pox, Rhazes  notes  the  frequency  of  the  disease  in  children,  and  gives  a most  minute 
account  of  the  semeiology,  differentiating  it  from  measles;  the  mild  and  fatal 
varieties  of  both  diseases  are  carefully  defined;  the  dangers  to  the  eyes,  ears,  nose, 
throat  and  joints  are  accentuated  in  a special  chapter;  the  prevention  and  treat- 
ment are  detailed  at  great  length,  viz.,  cupping  in  sucklings,  venesection  after  14, 
the  diet  “such  as  extinguishes  heat,”  snow-water  and  other  cooling  drinks,  acid 
fruits,  cold  baths,  etc.,  warm  compresses,  to  accelerate  the  eruption;  with  special 
treatment  for  the  eruption  and  the  scars. 

According  to  Hennig,  Rhazes  held  that  cheese  causes  calculi 
and  overfeeding  scrofula.  He  showed  that  the  urachus  lies  in  the 
umbilical  cord. 

The  “Canon”  of  Avicenna  (980-1036)  contains  (Lib.  I,  Fen.  3) 
four  chapters  on  the  hygiene  of  newborn  infants,  the  regimen  of 
the  diseases  of  infancy  and  the  hygiene  of  childhood,  followed  by 
19  chapters  on  the  hygiene  of  adolescence,  including  exercise,  bathing, 
diet,  sleep,  and  the  overcoming  of  lassitude. 

After  the  usual  directions  for  bathing  and  swathing  the  child  and  the  selection 
of  a wet-nurse,  the  following  diseases  are  mentioned  in  remarkable  terse  fashion, 
with  neither  definition  nor  semeiology,  but  a considerable  amount  of  dry  detail 
as  to  treatment:  vomiting,  abscesses  ( apostemata ) in  the  gums  and  mouth  during 
dentition,  tetanus,  cough,  rheumatism,  aphthae,  otitis  media,  meningitis  and  cere- 
bral abscess,  hydrocephalus,  conjunctivitis,  cataract  ( albedo  in  pupillis),  fevers, 
coryza,  pustules  on  the  body,  tumors  in  the  groin,  umbilical  abscess,  sleepless- 
ness, hiccough,  vomiting,  weak  stomach  ( stomachi  debilitas),  terrifying  dreams, 
abscess  in  the  throat,  stertorous  breathing  in  sleep,  tympanites  ( ventris  inflatio). 
hernia,  tenesmus,  worms  and  abrasion  of  the  hip  (femoral  intertrigo).  The 
subject  mtter  is  obviously  derived  from  Rhazes,  with  a few  extra  therapeutic 
wrinkles.  In  the  chapters  on  childhood  and  adolescence,  the  child  is  to  be  guarded 
against  excesses  of  temper  and  low  spirits  and  if  its  sleep  is  restless,  alternate 
playing  and  feeding  are  recommended.  At  six,  when  the  child’s  instruction  begins, 
it  should  be  allowed  to  learn  gradually  and  not  be  driven,  and  there  must  be  more 
exercise  before  eating  and  less  bathing.  Wine  is  interdicted,  as  a cause  of  conges- 
tion, choler  and  frequent  urination.  Exercise  is  treated  at  great  length. 


THE  MIDDLE  AGES 


55 


Avicenna  described  anthrax  (Persian  fire)  the  Guinea  worm 
( Vena  medinensis),  recognized  the  sweetish  taste  of  diabetic  urine 
(known  also  to  the  Hindus)  and  standardized  the  irrigation  of  wounds 
with  wine  for  the  entire  Middle  Ages.  The  Juntine  editions  of  1595 
and  1608  contain  striking  plates  of  the  Hippocratic  method  of  treating 
spinal  deformities  by  forcible  reduction,  reintroduced  by  Calot  in  1896. 

Ali  ben  Abbas  or  Haly  Abbas  ( -994  A.D.)  maintains  that  male 

infants  are  born  heavier  than  females,  mentions  a case  of  superfetation, 
recommends  treating  atresia  ani  with  the  finger  or  phlebotome,  and 
in  his  “Liber  Regius”  (I,  IX,  Chap.  63,  I,  19-22)  gives  some  details 
about  the  diseases  of  infancy  (Hennig). 

The  surgical  treatise  of  Albucasis  (11th  Century)  contains  chapters 
on  the  operative  treatment  of  infantile  hydrocephalus  (Chap.  1), 
the  extraction  of  teeth  (Bk.  II,  Chap.  30),  the  treatment  of  con- 
genital imperforate  urethra  (Chap.  55),  the  repairing  of  effects  of 
malpractice  in  circumcision  (Chap.  57),  the  treatment  of  imperforate 
anus  (Chap.  79). 


THE  MIDDLE  AGES 

In  the  Middle  Ages,  the  power  of  imperial  Rome  did  not  end 
with  the  downfall  of  the  Roman  Empire,  but  was  modified  by  the 
teachings  of  Christianity,  and  for  over  a thousand  years  the  great 
city  continued  to  be  a world-center  under  the  sway  of  the  Roman 
Catholic  Church.  The  utterances  of  Christ  himself  about  children, 
the  Latin  hymns  of  Ambrosius,  St.  Augustine’s  account  of  his  boyhood, 
and  the  many  figurations  of  the  Madonna  and  the  Christ-child  in  oil 
painting,  majolica  and  terra  cotta  are  all  eloquent  of  an  entirely  new 
feeling  toward  childhood  and  parenthood.  Through  the  influence  of 
Christianity,  edicts  against  infanticide  and  the  selling  of  children  into 
slavery  were  issued  by  the  Roman  emperors  Constantine  (315,  321), 
Valentinian,  Valens  and  Gratian  (374),  Valentinian,  Theodosius  and 
Arcadius  (391)  Honorius  and  Theodosius  (409),  Theodosius  II  (438), 
Valentinian  III  (451),  but  beginning  with  Barnabas,  a contemporary 
of  the  Apostles,  the  founders  of  Christianity  had,  long  before  this 
period,  established  the  fact  that  infanticide,  by  exposure  or  otherwise, 
is  a heinous  crime.  In  a long  series  of  bold,  vigorous  pronouncements 
addressed  directly  to  the  people,  the  fathers  of  the  Church  denounced 
infanticide  and  abortion,  in  the  manner  of  the  Hebrew  prophets.* 
The  belief  that  even  the  unborn  child  has  a “soul”  did  much  to  obliter- 
ate these  practices.! 

The  sentiment  goes  back  to  a passage  in  a letter  attributed  by 
Origen  to  Barnabas,  a contemporary  of  the  Apostles:  “Thou  shalt 
not  slay  the  child  by  procuring  abortion,  nor  again  shalt  thou  destroy 
it  after  it  is  born.”  Justin  Martyr  (2nd  Century  A.D.)  said  that 

* For  the  Latin  texts,  see  J.  F.  Terme  and  J.  B.  Monfalcon:  “Histoire  des 
enfants  trouves,”  Paris  (1840),  pp.  69-74;  and  the  effective  summary  of  Payne, 
op.  cit.,  pp.  257-271. 

fLecky,  “History  of  European  Morals,”  New  York,  ii  (1869),  pp.  34-36. 


56 


HISTORY  OF  PEDIATRICS 


“to  expose  newly  born  children  is  the  part  of  wicked  men”;  and,  with 
equal  force,  he  stigmatized  the  sin  of  rearing  girls  only  for  the  trade  of 
prostitution.  His  feeling  about  marriage  (“If  we  marry,  it  is  only 
that  we  bring  up  children”)  is  at  one  with  that  of  Virchow  (“Man 
schliesst  dock  keine  Ehe  urn  kinderlos  zu  bleiben”).  Tertullian  (200 
A.D.)  made  bold  to  address  the  sovereign  power  of  Rome  itself  in  the 
following  language:  “Rulers  of  the  Roman  Empire,  seated  for  the 
administration  of  justice  on  your  lofty  tribunal — you  first  of  all  expose 
your  children,  that  they  may  be  taken  up  by  any  compassionate 


Fig.  3. — Rogier  van  der  Weyden  (1400-1464) : St.  Luke  in  physician’s  garb. 

passer-by,”  and  addressing  the  people  themselves,  he  says:  “Although 
you  are  forbidden  by  the  laws  to  slay  new-born  infants,  it  so  happens 
that  no  laws  are  evaded  with  more  impunity  or  greater  safety,  with  the 
knowledge  of  the  public  and  the  suffrage  of  this  entire  age.”  Clement 
of  Alexandria  ( -220  A.D.)  said:  “Man  is  more  cruel  to  his  offspring 

than  animals.”  Minucius  Felix  (2nd  Century  A.D.),  a Roman  lawyer 
converted  to  Christianity,  attributed  the  practice  of  infanticide  to  the 
callous  pagan  trait  of  delight  in  bloody  sacrifice,  and  likened  those 
who  followed  it  to  aboriginal  Saturn,  who  devoured  his  own  offspring. 
Lactantius  (4th  Century  A.D.)  said  that  to  strangle  newborn  children 
is  the  greatest  impiety,  “for  God  breathes  into  their  souls  for  life,  not 
for  death.”  And  again,  he  says:  “It  is  as  wicked  to  expose  as  it  is 
to  kill.”  Basil  the  Great  (330-379  A.D.)  and  Ambrosius  (340-397 
A.D.)  fulminated  against  the  sale  of  free  children  to  gratify  the  avarice 
of  their  parents’  creditors.  The  exhortations  of  the  Fathers  were, 


THE  MIDDLE  AGES 


57 


in  time,  actually  read  into  the  decrees  issued  by  the  Councils  of 
the  Church,*  thus  continuing  the  spirit  of  the  edicts  pronounced 
by  the  better  sort  of  Roman  emperors.  In  314,  the  Council  of  Ancyra 
decreed  that  a woman  who  killed  her  offspring  should  not  be  per- 
mitted to  enter  a church  for  the  rest  of  her  life.  The  Council  of 
Nicaea  (325  A.D.)  decreed  that,  in  each  Christian  village,  a xeno- 
dochion,  or  hostelry  for  the  sick,  poor  and  vagrant,  should  be  estab- 
lished. Some  of  these  xenodochia  became  brephotrophia  or  asylums 
for  children.  The  Council  of  Vaison  (442)  provided  that  an  aban- 
doned child  should  find  sanctuary  in  a church  for  ten  days,  that  its 
parents  might  be  found,  after  which  false  claims  upon  the  child  Were 
punishable  by  the  Church  laws  against  homicide.  This  was  confirmed 
by  the  Councils  of  Arles  (452)  and  Agde  (505),  and  mothers,  who 
were  driven  to  abandon  their  new-born  offspring  through  shame 
or  poverty,  now  left  them  in  the  marble  receptacle  at  the  church 
door.  This  privilege  was  freely  granted  at  the  Council  of  Rouen. 
The  Council  of  Constantinople  (588)  compared  the  crime  of  infanticide 
to  that  of  homicide,  and  finally  Sixtus  V (1585-1590)  and  Gregory  XIV 
(1590-1591)  decreed  that  those  guilty  of  infanticide  should  suffer 
capital  punishment.  Finally,  the  legal  code  of  Justinian  (528-534) 
conferred  absolute  liberty  upon  foundlings,  and  a law  of  553  decreed 
severe  punishment  for  the  enslavers  of  exposed  infants.  These  drastic 
enactments,  which  indicate  the  frequency  of  infanticide  in  the  early 
days  of  Christian  Rome,  were  the  direct  outcome  of  the  teachings  of 
the  Fathers  of  the  Church.  When  we  reflect  that  much  of  the  antag- 
onism of  the  proud  Roman  toward  the  early  Christians  is  voiced  in  the 
famous  sarcasm  of  Gibbon — that  their  religious  scruples  “contributed 
rather  to  exclude  them  from  the  service  than  to  excuse  them  from 
the  honors  of  the  State  and  the  Army,”  we  can  appreciate  all  the 
more  the  courage  which  impelled  them  to  live  up  to  their  convictions 
in  the  stand  they  took  for  the  rights  of  the  child.  As  Payne  says,  when 
“Church  and  State  unite  in  defense  of  the  child’s  right  to  live,  then,  for 
the  first  time  in  history,  religious  and  civil  law  became -identical  with 
humane  sentiment.”  Among  the  Gaulish  and  German  barbarians,  the 
patria  potestas  was  absolute.  Exposure  and  infanticide  were  not 
infrequent,  and  were  punishable  in  the  Salic,  Alemannic,  and  Visigothic 
codes  by  a wergeld  (blood-money),  which  was  only  in  the  nature  of  a light 
fine.  The  Visigothic  Code  was  more  severe  in  the  matter  of  abortion. 

In  the  Dark  Ages,  thousands  of  children  were  exposed,  abandoned 
or  sold  into  slavery  by  the  impoverished  inhabitants  of  Gaul,  Germany 
and  Britain,  and  not  only  did  those  wanderers  sell  their  own  offspring 
and  the  exposed  infants  they  had  picked  up,  but  even  stole  the  children 
of  the  well-to-do  for  this  traffic.  Some  of  this  misery  was  alleviated  by 
holy  men,  who  purchased  these  children  outright  as  chattels  of  the 
Church. 

In  787,  Datheus,  Archbishop  of  Milan,  founded  the  first  asylum 
for  abandoned  infants  in  the  following  declaration: 

* Terme  and  Monfalcon,  op.  cit.,  pp.  78-81.  Payne,  op.  cit. 


58 


HISTORY  OF  PEDIATRICS 


“Now,  therefore,  I Datheus,  for  the  welfare  of  my  soul  and  the  souls  of  my 
associates,  do  hereby  establish  in  the  house  that  I have  bought  next  to  the  church, 
a hospital  for  foundling  children.  My  wish  is  that  as  soon  as  a child  is  exposed  at 
the  door  of  a church,  it  will  be  received  in  the  hospital  and  confided  to  the  care  of 
those  who  will  be  paid  to  look  after  them.”* 

The  foundlings  thus  cared  for  were  taught  a trade  and  given  their 
freedom  at  the  age  of  eight. 


Fig.  4. — Hans  Holbein  the  Elder  (1460—1524):  Birth  of  the  Virgin. 

Other  foundling  asylums  were  later  opened  at  Montpellier  (1010),  Marseilles 
(1199),  Embeck  (1274),  Venice  (1380)  and  Florence  (1421).  In  the  fifteenth 
century,  there  were  900  children  in  the  foundling  asylum  at  Naples.  Others 
existed  at  Rome,  Berglac  and  Troyes.  A new  asylum  was  opened  at  Milan  in 
1168,  and  in  1204,  Innocent  III,  moved  by  the  many  bodies  of  infants  fished  up  out 
of  the  Tiber,  dedicated  part  of  the  hospital  of  Santa  Maria  in  Sassia  (1198)  to  the 
care  of  foundlings.  The  famous  Spedale  degl’  Innocente  at  Florence  was  founded 
on  October  25,  1168.  Another  was  built  by  Brunelleschi  in  1450.  The  first 
combined  lying-in  hospital  and  foundling  asylum  was  founded  by  Enrad  Fleinz  at 
Nuremberg  in  1331.  In  1362,  a similar  orphan  asylum  was  founded  at  Paris.  A 
bull  of  Nicholas  IV  gives  a long  list  of  these  institutions  in  Italy,  Sicily,  Germany, 
England,  France  and  Spain. 


Payne,  op.  ait.,  p.  294. 


THE  MIDDLE  AGES 


59 


In  1523,  the  Hotel  Dieu  of  Lyons,  the  oldest  hospital  in  France, 
began  to  take  in  children.  But  the  new  movement  for  the  protection 
of  friendless  children  was  to  culminate  in  the  devotion  and  labors  of 
St.  Vincent  de  Paul  (1576-1660). 

In  the  art  of  the  Middle  Ages,  the  Madonna  and  Bambino  were 
favorite  themes  of  painters,  and  many  scenes  in  the  lying-in  room, 
including  the  bathing  and  swathing  of  the  new-born,  are  preserved  in 
oil,  fresco,  majolica,  ivory  relief  and  the  wood-cuts  of  the  time. 

The  lying-in  room  is  usually  represented  as  filled  with  busy  people, 
and  the  nurse-maid  is  often  figured  as  testing  the  temperature  of  the 
water  for  the  baby’s  bath  with  bared  feet.  Breast-feeding  was  the 
rule  everywhere,  and  the  wet-nurse  as  foster-mother  of  the  child,  held 
her  own  until  the  19th  century  when  “the  sucking-bottle,  a kind  of 
pocket  wet-nurse,  was  her  undoing”  (Forsyth).*  That  the  danger 
of  suffocating  infants  by  overlying  was  recognized  is  indicated  in  a 
German  placard  of  1291,  cited  by  Sudhoff  (Dresden  Catalogue,  item 
6375),  forbidding  mothers  from  taking  to  bed  with  them  infants  under 
three  years  of  age. 

In  medieval  medicine,  there  was  much  excellent  surgery,  and  the 
Jewish  concept  of  the  actuality  of  contagion  was  definitely  read  into 
the  many  hygienic  ordinances  improvised  by  municipalities  against 
leprosy,  bubonic  plague  and  syphilis.  Internal  medicine  was,  however, 
mainly  scholastic  in  character,  and  most  treatises  of  the  time  were 
either  translations  or  compilations  from  the  medical  writings  of  the 
ancients.  This  tendency  of  the  pre-Renaissance  period,  receptive  yet 
credulous,  may  be  summed  up  in  the  words  of  Dr.  Johnson,  f 

“Learning  was  then  rising  in  the  world;  but  ages  so  long  accustomed  to  dark- 
ness were  too  much  dazzled  with  its  light  to  see  anything  distinctly.  The  first 
race  of  scholars  in  the  fifteenth  century,  and  some  time  after,  were  for  the  most 
part,  learning  to  speak  rather  than  to  think,  and  were  therefore  more  studious  of 
elegance  than  of  truth.  The  contemporaries  of  Boethius  thought  it  sufficient  to 
know  what  the  ancients  had  delivered.  The  examination  of  tenets  and  of  facts 
was  reserved  for  another  generation.” 

In  other  words,  the  internists  of  the  time  frittered  awTay  their 
opportunities,  for  the  most  part,  in  the  attempt  to  achieve  huge 
summaries  of  everything  known  in  the  past  ( summa  medicinalis) , after 
the  fashion  of  Galen,  the  Byzantine  writers  and  Avicenna.  Where 
internal  medicine  is  really  forward  and  flourishing,  as  in  the  eighteenth 
century,  pediatrics  is  sure  to  thrive. 

The  Middle  Ages  made  no  contributions  of  value  to  the  literature 
of  pediatrics,  unless  we  include  the  three  treatises  of  Bagellardo, 
Metlinger  and  Roelants,  which  were  published  by  authors  who  flour- 
ished long  after  the  invention  of  printing. 

* D.  Forsyth,  Proc.  Roy.  Soc.  Med.,  London,  iv  (1910-11),  pt.  1,  Sect.  Dis. 
Child.,  p.  113. 

t Samuel  Johnson,  “A  Journey  to  the  Western  Islands  of  Scotland.”  London, 
(1775). 


60 


HISTORY  OF  PEDIATRICS 


In  the  palmy  days  of  the  School  of  Salerno,  the  writers  of  the  twelfth  and 
thirteenth  centuries  began  to  produce  lengthy  treatises  on  the  practice  of  medicine, 
in  which  the  different  local  diseases  were  handled  seriatim  “from  head  to  heel” 
(a  capite  ad  calcem).  Pediatric  knowledge,  in  such  treatises  as  these,  was  not 
segregated  and  individualized,  but  was  scattered  about  through  the  chapters 
on  epilepsy  and  other  diseases  liable  to  affect  infancy.  Thus  the  gynecological 
treatise  of  Trotula  ( De  passionibus  mulierum)  contains,  contrary  to  ancient  custom, 
short  chapters  on  the  regimen  of  infancy,  the  election  of  a wet-nurse,  and  no  more. 
This  is  also  true  of  the  Physica  of  St.  Hildegarde  (1099-1179).  The  obstetric 
portion  of  the  Breviary  of  Arnold  of  Villanova  (1235-1312)  treats  of  a few  female 
complaints  with  lengthy  directions  for  the  prevention  of  conception  and  the 
artificial  production  of  pseudo-virginity  ( ut  mulier  non  condpiat,  et  ut  virgo  videatur). 
The  same  thing  (De  sophisticatione  vulvce)  is  found  in  the  Compendium  medicinae 
(1510)  of  Gilbertus  Anglicus  (Handerson).  The  13th  century  Regime  du  corps 
of  Aldebrandino  of  Sierra  contains  two  short  chapters  on  the  hygiene  of  infancy, 
childhood  and  adolescence.*  The  later  writers  on  internal  medicine,  were,  by 
preference,  translators,  “aggregators”  (compilers),  “concorders”  (arrangers) 
and  “conciliators”  (reconcilers  of  disparate  doctrine).  In  the  huge  treatises 
of  Gilbertus  Angelicus  ( -1250),  Taddeo  Alderotti  (1223-1303),  Peter  of 

Abano  1250-1315),  Bernard  de  Gordon  ( circa  1285-1307),  and  Niccolo  Falcucci 
( -1412),  pediatrics  is  not  anywhere  featured  as  a separate  subject,  as  in 

Soranus,  Oribasius  and  Paul.  The  Practica  of  Savonarola  (1390-1462)  again  treats 
only  of  diseases  “from  top  to  toe”  ( a capite  ad  pedes),  after  the  Salernitan 
fashion.  The  tendency  of  internal  medicine  was  purely  scholastic.  The  out- 
standing contribution  of  the  Middle  Ages  to  infant  welfare  is  to  be  found,  not  in 
the  books,  but  in  the  efforts  of  the  Church  to  check  abortion  and  infanticide. 

THE  RENAISSANCE  PERIOD 

(1453-1600) 

The  Revival  of  Learning  in  Europe  really  began  with  the  printing 
of  the  Gutenberg  Bible  at  Mainz  (1454),  one  year  after  the  fall  of 
the  Eastern  Roman  Empire  (1453).  After  that  event,  the  Greek 
scholars  of  Byzantium  began  to  pour  into  Italy,  and  after  the  sack  of 
Mainz  (1462),  the  German  printers  spread  over  Europe,  and  began  to 
publish  books  everywhere.  The  effect  of  all  this  was  to  disseminate 
knowledge  in  a rapid,  effective  manner,  and  with  the  revival  of  Greek 
culture  there  arose  a new  species  of  physicians,  the  medical  philologists 
who  supplanted  the  medieval  compilers  and  commentators,  and  intro- 
duced the  critical,  challenging  spirit  in  their  examination  of  the  older 
medical  writings.  In  Germany,  France  and  England,  many  medical 
books  and  tracts  were  published  for  the  first  time  in  the  vernacular, 
and,  through  this  medium,  botany,  surgery,  obstetrics,  ophthalmology 
took  on  a new  lease  of  life.  Anatomy  received  a tremendous  impetus 
at  the  hands  of  Leonardo  da  Vinci,  Vesalius,  Eustachius  and  Fallop- 
pius,  pathology,  was  forwarded  by  Benivieni,  the  modern  theory  of 
contagion  was  stated  in  striking  form  by  Frascastorius,  chemical 
therapeutics  was  grounded  by  Paracelsus,  and  gynecology,  pediatrics, 
medical  jurisprudence  and  veterinary  medicine  began  to  be  individual- 
ized in  books  devoted  to  these  specialties  alone. 

Infantile  mortality  in  the  sixteenth  and  seventeenth  centuries 

* Le  Regime  du  Corps  de  Maitre  Aldebrandin  de  Sienne,  texte  francaise  du 
xiiie  siecleed.  L.  Landouzy  et  R.  Pepin,  Paris  (1911),  pp.  74-SO. 


THE  RENAISSANCE  PERIOD 


61 


was  very  high,  owing  to  the  low  estate  into  which  public  and  personal 
hygiene  had  fallen,  on  account  of  the  many  wars  and  epidemics 
with  which  Europe  had  been  plagued,  and  the  indifference  of  the 
aristocracy  to  the  misery  of  the  people.  By  decrees  of  the  Parliament 
of  Paris  in  1547  and  later,  the  great  nobles  were  required  to  care 
for  the  foundlings  abandoned  in  their  domains,  but  the  mandates 
were  evaded  or  neglected.  Although  the  churches  and  monasteries 
still  looked  after  infants  left  at  their  doors,  children  were  frequently 
found  dead  from  cold  and  hunger  on  the  streets,  or  were  fished  up 
drowned  out  of  the  sewers.  Froude,  at  the  beginning  of  his  History 
of  England,  speaks  of  the  almost  stationary  condition  of  the  English 
population  at  this  time.  Yet  the  artists  of  the  German  and  Italian 
Renaissance  glorified  maternity  as  the  chief  end  of  womanhood, 
and  the  lying-in  room  was  frequently  represented  by  Holbein  and 
others,  showing  the  modes  of  bathing,  swaddling  and  cradling  the 
infant,  the  nurse  usually  testing  the  temperature  of  the  water  with 
her  bared  foot. 

Of  the  many  pediatric  treatises  and  tracts  of  the  Renaissance 
period,  the  earliest  were  the  late  fifteenth  century  incunabula  of 
Bagellardo,  Metlinger  and  Roelants,  the  latter  of  which  was  destined 
to  be  almost  obliterated  under  the  name  of  Sebastianus  Austrius. 

Pietro  Bagellardo,  of  Fiume  (Bagellardus  de  Flumine)  ( -1494) 

began  to  teach  philosophy  at  the  High  School  in  Padua  in  1441,  and 
medicine  about  1444-58.  In  1472,  he  became  professor  ordinarius  of 
theoretical  medicine,  and  continued  to  teach  at  Padua  for  eight 
years.  He  was  known  and  respected  even  at  Venice,  whither  he  was 
invited  by  the  Doge  to  view  the  remains  of  St.  Luke  in  the  church 
of  St.  Justina.  He  settled  in  Venice  in  1480,  and  died  there  in  1494.* 
In  1472,  he  published  the  first  distinct  treatise  on  pediatrics  (De 
aegritudinibus  infantium ) one  of  the  first  medical  incunabula  to  be 
printed.  Three  separate  editions  of  this  work  exist,  viz.,  the  small 
quarto  of  40  leaves  (80  pages)  published  at  Padua  on  April  21,  1472 
(Hain,  2244),  an  Italian  edition  {sine  loco)  published  on  March  10, 
1486  (Reichling,  414)  and  the  Paduan  edition  published  on  November 
10,  1487  (Hain,  2245). f The  editions  of  1472  and  1488  can  be  seen  in 
the  Surgeon  General’s  Library. 

This  treatise,  which  follows  that  of  Rhazes  very  closely  in  arrangement  of 
contents  and  subject  matter,  begins  with  a florid  dedication  to  Niccolo  Truno, 
Duke  of  Venice,  passing,  over  the  page,  into  Part  I,  which  deals  with  the  care  of 
the  infant  in  the  first  month  of  life.  After  the  usual  obstetric  directions  as  to  the 
careful  examination  of  the  newborn  before  severing  the  umbilical  cord,  the  nurse 
is  directed  to  place  the  child  in  a pleasantly  warm  bath,  neither  too  hot,  nor  too 
frigid,  and  not  salted  after  the  Greek  fashion;  the  child’s  head  being  supported 
by  the  left  hand  of  the  nurse  and  the  right  hand  cleansing  all  parts  of  the  body 
with  gentle  friction;  the  child  is  then  carefully  wiped,  swathed  and  cradled  in  a 
cool  shady  part  of  the  house;  its  first  food  should  be  sugared  baked  apple  ( pomi 
cocti  perfecta  coctione  permixto  zucaro).  Minute  directions  for  lactation,  choice  of 

* K.  Sudhoff,  Janus,  Amsterdam,  xiv  (1909),  pp.  468-469. 

t The  bracketed  figures  refer  to  the  check  numbers  of  these  incunabula  in  the 
catalogues  of  Hain  and  Reichling. 


62 


HISTORY  OF  PEDIATRICS 


wet-nurse  and  care  of  the  child  up  to  the  end  of  the  first  month  follow.  The  direc- 
tions for  crooning  a song  while  rocking  the  cradle  read  very  quaintly.  Part  II 
consists  of  22  chapters  dealing  with  infantile  diseases,  viz.,  saphatie  (tinea  capitis) 
and  favus,  epilepsy,  colic  (spasmus),  wakefulness,  eye  diseases  (ophthalmia, 
tumefaction,  strabismus),  ear  diseases  (hemorrhage,  otorrhea),  abscess  of  the  ear, 
aphthae  ( alcola ),  gingivitis,  fissure  of  the  lips,  abscess  of  the  throat,  cough  and 
rheumatism,  diarrhea  ( fluxus ),  constipation  (stipticitas) , tenesmus,  worms, 
tympanites  (tumor  ventris),  dysuria,  incontinence  of  urine,  umbilical,  inguinal  and 
scrotal  hernia  ( ramex ) and  pruritus,  pustules  or  excoriations  (intertrigo)  on  the 
legs,  thighs,  back  and  body. 

Bartholomseus  Metlinger,  a son  of  Peter  Metlinger,  an  Augsburg 
physician,  is  mentioned  in  the  tax-lists  of  Augsburg  for  1472,  and, 
in  the  same  year,  was  enrolled  for  instruction  at  the  new  University 
of  Ingolstadt.  He  died  circa  1491-2,  leaving  a widow  and  children.* 
On  December  7,  1473,  his  “Regiment  der  j ungen  Kinder,”  a folio  incun- 
able  of  27  leaves  (Hain,  1112)  was  published  at  Augsburg  by  Gunther 
Zainer.  This,  the  earliest  pediatric  treatise  in  the  vernacular,  passed 
through  8 editions  (1474,  1476,  1497,  1500,  1511,  1531,  1539)  and  was 
turned  into  modern  German  by  Ludwig  Unger  in  1904.  f The  1497 
edition  has  an  illustrated  title-page,  representing  a German  domestic 
interior,  with  a swaddled  child  in  the  cradle,  rocked  by  its  mother’s 
foot.  This  work,  in  essence  a popular  treatise,  is,  as  Abt  says,  of 
doubtful  scientific  value. 

Metlinger  draws  liberally  upon  the  Greek  and  Arabian  writers.  Chapter  I 
deals  with  infant  hygiene  up  to  walking  and  talking,  after  the  practical  fashion  of 
Soranus.  Chapter  II  deals  with  infant  nutrition.  It  contains  the  first  mention  of 
the  nippled  nursing  can  (“tiitlein  oder  krieglein”)  and  the  artificial  teat  (zepflin) 
for  pap.  Chapter  III  with  eruptions  of  the  scalp  and  face  (nerys),  for  which  a 
mercurial  salve  is  recommended,  hydrocephalus  (W echselbalg) , meningitis  ( durslig ), 
wakefulness  (Wachen),  convulsions  (Vergicht),  paralysis,  otorrhea,  conjunctivitis, 
strabismus,  teething,  tumors  of  the  neck,  aphthae,  bronchial  catarrh,  disorders 
of  digestion,  jaundice,  diarrhea  (rur),  constipation,  prolapse  of  the  rectum,  worms 
and  pains  in  the  body,  umbilical  and  scrotal  hernia,  urinary  calculus,  cutaneous 
ulcers,  fever,  erysipelas  (gesegnet  oder  ungenad),  measles  and  smallpox  (durch- 
schlechten  und  platern).  The  therapy  is  extensive,  often  based  on  personal  expe- 
rience (“und  ich  hab  es  bewart”).  Chapter  IV  deals  with  teaching  the  child  how 
to  run,  and  its  training  up  to  the  sixth  year,  when  it  should  begin  studies.  Wine 
should  not  be  given  to  children  under  7,  preferably  not  to  boys  before  12,  nor  to 
girls  before  14. 

The  pathology  is  throughout  humoral  (Sudhoff).t 

Cornelius  Roelants  (1450-1458),  of  Mechlin  (Brabant),  matricu- 
lated (1466)  at  the  University  of  Louvain,  where  he  graduated  in 
medicine  in  February,  1480,  and  was  hospital-  and  city-physician  at 
Mechlin  during  1498-1525.  He  became  a highly  esteemed  practitioner 
among  the  nobility,  even  attending  the  daughter  of  Emperor  Maxi- 
milian. On  February  10,  1494,  he  married  Caecilia  von  Duffel,  who 
died  on  February  16,  1519,  leaving  a son  and  a daughter.  Roelants 

* Huber,  Miinchen.  med.  Wochenschr.,  lv  (190S),  p.  1499. 

fL.  Unger,  “Das  Ivinderbuch  des  Bartholomaus  Metlinger.”  Leipzig  (1904k 

t K.  Sudhoff,  “Deutsche  Medizinische  Inkunabeln.”  Leipzig  (190S),  pp. 
38-43.  For  a good  analysis  of  the  contents  of  Metlinger,  see  R.  Landry,  Wien, 
med.  Presse,  xliv  (1904),  pp.  1382-1390. 


THE  RENAISSANCE  PERIOD 


63 


himself  died,  at  the  age  of  75,  on  September  1,  1525  (Sudhoff).  About 
1483—4,  he  published  a pediatric  treatise  of  117  leaves  (numbered 
78-194)  of  which  only  the  first  77  are  printed.  The  book  is  dedicated 
to  Philip  I (the  Fair),  Duke  of  Burgundy.  Of  this  incunable,  exhumed 
by  Sudhoff,  only  two  perfect  copies  are  known,  viz.,  those  in  the  Hun- 
terian Museum  at  Glasgow  and  the  University  Library  at  Leipzig, 
but  there  are  a few  loose  leaves  in  the  University  Library  at  Cambridge. 
Although  this  text  is  not  accessible,  a good  account  of  it  is  given  by  its 
discoverer,  Sudhoff.* 

After  the  fashion  of  the  pre-Renaissance  compilers  who  sought  to  arrange 
seriatim  all  the  opinions  of  earlier  writers  on  a given  subject,  Roelants  styles  him- 
self “aggregator  Cornelius’’  and  “aggregator  Mechlinensis,”  patting  his  authorities 
on  the  back  with  a personal  “bene  dicit.”  He  draws  on  all  known  sources,  from 
Hippocrates  and  Rhazes,  Gerard  of  Cremona  and  Gilbertus  Angelicus,  to  Salieeto 
and  Argillata.  Sudhoff  has  further  traced  his  sources  to  an  anonymous  pediatric 
MS.  of  the  13th  century  which  he  has  exhumed  in  no  less  than  17  medieval  codices 
in  the  Vatican,  Oxford  and  elsewhere,  and  to  a pseudo-Galenic  “ practica  puerorum” 
of  late  antiquity,  in  two  MS.  codices  at  Florence  (14th  century)  and  Prague 
(15th  century).  Although  Roelants  compiles  opinions  as  a professional  “aggre- 
gator,” he  does  not  withhold  his  own  experience.  He  speaks  of  the  advantages 
of  blood-letting  in  the  nurse  instead  of  the  infant;  recommends  the  blue  ring-dove 
above  other  doves  as  an  article  of  infantile  diet;  shows  how  the  lentil  of  the  Low 
Countries  may  be  substituted  for  the  “ligni  cornua;”  describes  cancrum  oris, 
feeble  locomotion,  tumors  and  treatment  of  ear  diseases  from  his  own  experience; 
and  criticizes  textual  corruptions  in  the  MS.  of  Avicenna. 

Fifteen  years  after  the  death  of  Roelants,  as  Sudhoff  has  shown,  f 
the  credit  of  his  work  was  practically  taken  away  from  him  by  Sebas- 
tian Ostricher  (Sebastianus  Austrius)  ( -1550),  of  Ruffach 

(Alsace),  a learned  philological  physician  who  practised  at  Colmar  and 
published  a commentary  on  the  section  on  personal  hygiene  in  Paul  of 
iEgina  (1538).  Exasperated  by  the  “barbarous  kitchen-Latin ” of 
Roelants,  Ostricher  undertook  to  make  the  text  more  readable  and,  in 
1540,  issued  it,  rearranged,  emendated  and  dressed  up  for  posterity,  as 
a new  work,  under  his  own  name.  Although  he  acknowledges  the 
Flemish  physician’s  work  as  the  basis  of  his  own  in  the  preface,  he 
ignores  him  on  the  title-page,  and  the  book  of  Roelants,  in  this  form,  is 
now  known  to  pediatrists  as  “Sebastianus  Austrius.”  This  book  was 
reissued  at  Leyden  in  1544,  and  again,  with  a commentary  by  Nicolaus 
Fontanus,  at  Amsterdam  in  1642.  As  a summarizer  of  then  existing 
knowledge,  Sebastianus  Austrius,  the  supplanter  of  Roelants,  is 
credited  with  the  outstanding  pediatric  text  of  the  sixteenth  century. 

Omitting  infant  hygiene  and  nutrition,  the  author  plunges  into  his  subject 
with  descriptions  of  54  diseases  arranged  “a  capite  ad  calcem”  (from  siriasis  to 
femoral  intertrigo),  in  as  many  chapters.  The  treatment  is  scholastic  and  the 
work  should  be  of  great  value  to  pediatrists  who  wish  to  trace  the  changes  of  doc- 
trine in  the  texts  of  classical  antiquity  and  the  Middle  Ages.  The  titles  of  dis- 
eases heading  the  successive  chapters  include  all  the  synonyms,  as  in  the  Systems 
of  Allbutt  and  Osier.  The  saphatie  of  Avicenna  is  identified  with  tinea  capitis, 
favus  (Rhazes)  is  “kerion;”  night-fears  are  “pavores”  (Hippocrates,  Galen); 

* Sudhoff,  Janus,  Amst.,  xiv  (1909),  p.  465;  xx  (1915),  p.  443. 

t Sudhoff,  Janus,  Amst.,  xiv  (1904),  pp.  481-484. 


64 


HISTORY  OF  PEDIATRICS 


epilepsy  is  the  morbus  coviitialis  of  the  Greeks,  the  mater  puerorum  of  the  Romans, 
and  the  morbus  regius  of  the  vulgar;  paralysis  is  “resolutio  nervorum;”  infantile 
convulsions  may  range  from  colic  to  tetany;  glaucedo  (yXothKo/xaTa)  or  hypochy- 
mata  is  not  the  glaucoma  of  Graefe,  but  a greenish  suffusion  of  the  eyes;  ptilosis 
and  psorophthalmia  are  featured;  the  parulides  of  Paul  are  abscesses  of  the  gums 
and  jaws;  epulis  is  the  vesica  of  Rhazes;  aphthae  is  synonymous  with  alcola 
(Avicenna),  calaba  (Paul)  and  ulcus  oris  (Pliny);  quinsy  is  squinantia;  a weak 
stomach  is  stomachus  fractus  (Avicenna) ; diarrhea  is  alvi  fluor,  constipation  alvus 
sicca;  the  chapter  on  incontinence  of  urine  is  entitled  “de  meientibus”  (Paul). 
The  work  is  prefaced  by  a dedication  to  Ferdinand,  King  of  Bohemia,  and  the 
Hippocratic  aphorisms  on  infantile  diseases.  It  concludes  with  19  aphorisms 
on  infant  hygiene  and  nutrition,  of  which  the  following  are  samples: 

3.  The  infant  is  to  be  fed  solely  on  milk  up  to  dentition. 

4.  Wine  and  beer  are  harmful  to  children  as  befogging  the  brain  and  perturbing 
the  mind  by  heat. 

17.  Three  modes  of  lightening  the  pangs  of  infancy:  apposition  of  the  nurse’s 
breast,  gentle  dandling  and  pleasant  modulation  of  the  voice. 

18.  Red  coral  suspended  to  the  suckling’s  neck,  reaching  from  the  mouth  to  the 
stomach,  prevents  the  vomiting  of  milk  and  promotes  its  digestion. 

A work  of  the  same  scholastic  stamp  is  the  large  quarto  treatise 
(De  morbis  puerorum  tractatus ) of  Geronimo  Mercuriali  (1530-1606), 
of  Forli,  published  at  Venice  in  1583.  Mercuriali  was  a learned 
medical  graduate  of  Padua,  who  acquired  his  extensive  knowledge  of 
ancient  medicine  by  seven  years  of  study  at  Rome,  at  the  instance 
of  Cardinal  Farnese.  He  held  the  chairs  of  medicine  at  Padua  (1569- 
87),  Bologna  (1587-99)  and  Pisa  (1599-1606).  In  1569,  he  published 
a learned  illustrated  treatise  on  the  gymnastics  of  the  ancients,  which 
passed  through  five  editions  and  made  his  reputation  along  with  the 
first  formal  treatise  on  skin  diseases  (1572),  a treatise  on  gynecology 
(1582)  a bilingual  (Greek  and  Latin)  edition  of  Hippocrates  (1578) 
and  many  learned  commentaries  on  Hippocrates  and  on  difficult 
passages  in  the  ancient  writers  (1571).  His  medical  treatises  were 
spoiled  by  the  fact  that  he  allowed  his  pupils  to  prepare  them  for  the 
press.  In  consequence,  the  style  is  diffuse  and  verbose. 

The  pediatric  treatise,  described  by  Hennig  as  “an  inconsiderable  book  which 
long  passed  as  authoritative,”  was  reprinted  twice,  the  second  edition  (1584) 
containing  Mercuriali’s  translation  of  Alexander  Trallianus  on  worms.  As  with 
Roelants  and  Austrius,  the  text  of  Mercuriali  is  that  of  a medieval  “aggregator.” 
The  work  is  divided  into  three  books,  the  third  being  devoted  entirely  to  intestinal 
worms,  j The  arrangement  of  chapters  is  irregular;  the  longest  are  those  on  measles 
and  smallpox,  emaciation  (de  made),  epilepsy,  and  stammering.  Among  the  new 
titles  included  are  scrotal  hernia  (ramex),  intertrigo,  pernio,  putrid  fever  ( febris 
synochus),  disordered  speech,  mutism,  disorders  of  sensation  (de  vitiis  sensus 
communis),  dyspnea  and  scrofula.  On  the  whole,  as  Hennig  intimates,  a much- 
overrated book. 

Perhaps  the  earliest  pediatric  treatise  in  the  vernacular  is  “ The 
Boke  of  Children”  of  Thomas  Phayre  (or  Faier)  (15107-60),  a charming 
black-letter  appended  to  “The  Regiment  of  Life”  (London,  1545),  a 
popular  version  of  the  Salernitan  “Regimen  sanitatis”  by  the  same 
author.  Phayre  was  a learned  lawyer,  physician  and  translator,  an 
Oxford  M.  D.  of  1558,  who  later  Englished  the  first  seven  books  of  the 
/Eneid. 


THE  RENAISSANCE  PERIOD 


65 


He  begins  his  little  pediatric  tract,  with  a frank  avowal  of  his  disinclination 
to  deal  with  the  generation  and  hygiene  of  the  infant  as  “pertaining  only  to  the 
office  of  a midwife,”  yet  none  the  less  he  goes  into  infant  nutrition  through  8 
pages,  urging  that  the  mother  nurse  her  own  child.  He  then  gives  brief  descrip- 
tions of  40  diseases,  the  “remedye”  being  paragraphed  in  each  case.  Among 
these  are  “aposteme  of  the  brayne,”  “swelling  of  the  head,”  “watching  out  of 
measure”  (wakefulness),  “terrible  dreams,”  “the  fallvng  evill”  (epilepsy), 
“crampe,”  “styfnesse  of  lymmes,”  “bloodshoten  eyes,”  “nesying  out  of  measure” 
(coryza),  “Quynsye,”  “straytnesse  of  wynde”  (dyspnea),  “colvke  and  rumblvng 
in  the  guttes,”  “brustvnge”  (scrotal  hernia),  “fallyng  of  the  fundament,”  ague, 
“kybbes”  (pernio),  and  “swellyng  of  the  coddes,”  which  may  be  the  orchitis  of 
mumps  (Hippocrates).  The  descriptions  of  diseases  have  a quaint  practical 
flavor;  the  treatment  is  mainly  herbal,  and  sometimes  suggests  the  “frightfulness” 
of  the  first  London  Pharmacopoeia  (1618). 

A far  more  original  pediatric  treatise  than  any  of  those  mentioned  is 
that  appended  to  the  1612  edition  of  the  Practica  der  Wundartzney 
(1598)  of  the  Swiss  surgeon  Felix  Wiirtz  (1518-1575),  which  in  the 
English  translation  of  1656,  appears  as  The  Children’s  Book.  This 
“Children’s  Book,”  the  work  of  a natural-born,  self-taught  surgeon,  is 
delightfully  fresh  and  vigorous,  does  not  lean  upon  the  old  authors, 
actually  tells  us  something  new,  and  is,  even  today,  a living  demon- 
stration of  the  fact,  that  the  surgeon  of  Renaissance,  dealing  daily  with 
the  data  of  actual  experience,  was  capable  of  better  and  more  practical 
bedside  thinking  than  the  clinical  scholiast  of  the  period.  “ I presume 
not  to  write  of  things  which  I never  had  an  experience  of,”  says  Wiirtz 
— “those  I leave  unto  wiser  men.”  This  little  book  is  also  the  first 
treatise  on  infantile  surgery. 

After  some  sensible  directions  as  to  the  choice  of  a wet-nurse,  Wiirtz  vigorously 
scores  the  practice  of  tight  swaddling ; gives  timely  cautions  as  to  the  posture  of  the 
child  in  the  cradle,  the  need  for  gentle  rocking;  attention  to  the  cause  of  crying; 
cramp  from  lying  in  wet  or  cold  places,  bathing  and  prompt  wiping,  especially  of 
the  head.  Scrubbing  the  interior  of  the  mouth  is  particularly  bad  in  thrush,  and 
blisters  of  the  cheeks,  tongue  or  throat.  The  Swiss  methods  of  spoon-feeding,  to 
prevent  burning  with  hot  pap  are  described,  with  the  danger  of  injuring  the  child’s 
mouth  by  the  spoon,  and  the  drinking  bottle  is  to  be  watched  as  a source  of  putre- 
faction. Itching,  burning  blisters,  “fellow  feeders”  (comedones),  smarting  pains, 
running  eyes,  sore  eyes  are  paragraphed.  Wiirtz  gives  his  own  personal  experience 
as  to  the  harmful  effects  upon  the  eyes  of  bright  light  and  shining  things  generally. 
Conrad  Gesner  himself  prescribed  venesection  in  his  case.  “Winding  children 
into  clouts”  is  again  denounced,  and  a long  orthopedic  section  “of  crooked  and 
lame  children”  follows:  “a  fit  garment  for  children  to  wear  in  their  cradles,”  the 
danger  of  rough  dandling,  carrying  and  dancing  on  the  knee,  fractures,  dislocations, 
convulsions  and  blindness  from  these  causes,  the  dangers  of  too  early  standing  and 
walking  by  means  of  stocks  and  running  stools,  and  the  necessity  of  protecting  the 
child’s  face  from  flies,  make  up  the  rest  of  this  straightforward  exhortation.  The 
surgeon’s  quaint  piety,  his  big  humanity,  and  his  vigorous  vernacular  suggests 
the  sermons  of  Bishop  Latimer  (1562)  and  Abraham  £ Sancta  Clara.  As  the  first 
contribution  to  infantile  orthopedics,  this  little  work  is  easily  the  most  original 
pediatric  treatise  of  the  sixteenth  century. 

Other  pediatric  treatises  were  published  by  Michel  Angelo  Blondi  (Venice, 
1537),  Petrus  Jacobus  Toletus  (Leyden,  1538),  Paul  Cornelius  (Basel,  1540), 
Hieronymous  Montanus  (Lyons,  1550),  Ludovico  Lobera  de  Avila  (Pincia,  1551), 
Marco  Mironi  (Turin,  1553),  Leonelli  (Venice,  1557),  Johan  Kueffner  (Venice, 
1557),  B.  Russeus  (Louvain,  1559),  L.  Faventinus  de  Victoriis  (Leyden,  1574), 
Omnibonus  Ferrarius  (Brescia,  1577),  and  Jacob  Tronconi  (Florence,  1594).  A 
Vol.  I — 5 


66 


HISTORY  OF  PEDIATRICS 


French  medical  poem  on  breast  feeding  ( Maniere  de  nourrir  les  enfans  a la  mamelle ) 
was  published  by  Scaevola  Gaucher  de  St.  Marthe  in  1598,  and  translated  in 
English  as  “ Paedatrophia”  by  H.  W.  Tytler  (London,  1797).  Tracts  and  d:  - 
sertations  on  monsters  by  Sorbinus  (1570),  Limmer  (1594),  Euonymus  (1595)  a ; 
Winrich  (1595);  a poem  on  infantile  atrophy  by  Julius  Alexandrini  (Zurich,  1550 
a dissertation  (De  tabe  infantum ) by  Reusner  (Basel,  1582);  a colloquy  on  dentitic  ; 
by  F.  M.  de  Castrillo  (Valladolid,  1557);  dissertations  on  worms  by  H.  Bri 
(1.540),  H.  Gabucinus  (1549),  Savanarola  (1560),  Nymann  (1594),  Hoffma 
(1595),  and  a dissertation  on  rachitic  infantile  atrophy  by  Teichmeyer  (Jen: 
(1515)  are  listed  in  Meissner’s  bibliography  of  pediatrics. 

The  epidemics  of  smallpox  and  measles  in  Germany  (1493),  Sweden  (1578 
and  elsewhere  occasioned  a large  number  of  tracts  on  smallpox  and  measles  which 
were  a sort  of  prelude  to  the  vast  smallpox  literature  of  the  seventeenth  and 
eighteenth  centuries.  Syphilis,  first  mentioned  in  the  Edict  against  Blaspheme  - 
of  Maximilian  I (1495)  and  named  in  the  poem  of  Frascastorius  (1530),  was  the 
subject  of  a large  number  of  treatises  by  Konrad  Schelling  (1496),  Joseph  Griinpeck 
(1496),  Leonicenus  (1497),  Joh.  Widmann  (1497),  Montagnana  (1498),  Torelia 
(1500),  Lacumarcino  (1524  vel  subseq.),  Massa  (1532),  Fernelius  (1538),  Fallopius 
(1564)  and  Luisinus  (1566).  Among  the  original  descriptions  of  new  diseases  wei  e 
those  of  typhus  fever  by  Fracastorius  (1546),  varicella  by  Ingrassias  (15d 
tabardillo  or  Mexican  typhus  by  Francesco  Bravo  (1570),  and  chlorosis  (morbus 
virgineus  by  Johann  Lange  (1554).  Whooping  cough  (quinta)  was  described 
the  first  time  in  1578  by  Guillaume  de  Baillou  or  Ballonius  (1538-1616),  a dean  o 
the  Paris  faculty,  whose  posthumous  writings  include  treatises  on  convulsions 
(1640),  rheumatism  and  dorsal  pleuritis  (1642),  diseases  of  virgins  and  matrons 
(1643),  and  a disputation  of  1595,  in  which  it  is  maintained,  in  consonance  with  the 
old  Hippocratic  teaching,  that  those  who  acquire  a gibbous  spine,  from  cough  or 
asthma,  before  puberty,  will  soon  die.  Baillou’s  account  of  whooping  cough  was 
followed  by  the  “Synopsis  non  morbi”  of  Beckel  (Helmstadt,  1580),  in  which  the 
ravages  of  the  disease  (catarrhus  febrilis)  through  the  length  and  breadth  of 
Europe  are  described. 

The  facies  of  adenoid  vegetations  is  reproduced  for  the  fi  st 
time,  sans  le  savoir,  in  Lucas  van  Leyden’s  portrait  of  Ferdinand  I >!’ 
Spain  (1524),  and  the  many  paintings  of  the  prognathous  Hapsbui 
and  Medici  would  now  be  regarded  by  dentists  as  figuration 
of  malocclusion. 

In  the  late  fifteenth  and  sixteenth  centuries,  all  modes  of  artific  il 
nutrition  of  infants  were  in  vogue.  In  default  of  the  mother’s  brea  - ‘ 
or  the  wet-nurse,  the  child  was  fed  on  cow’s  milk  or  goat’s  milk 
means  of  sucking  horns,  sucking  cans  with  artificial  nipples,  the  spoon, 
or  by  sugar  lumps  and  bread  rubbed  into  a piece  of  linen,  shaped  into  an 
artificial  nipple. 

The  sucking  horn  (cornette)  is  mentioned,  in  Robert  le  Diable,  a French  metri 
romance  of  the  13t.h  century,  in  Die  gute  Frau,  a German  poem  of  the  same  peri 
and  in  the  Autobiography  of  Thomas  and  Felix  Platter  (16th  century),  in  which 
Thomas  describes  himself  as  weaned  by  means  of  a horn,  his  mother  not  being  able 
to  nurse  him  on  account  of  inflammation  of  the  breast.  The  sucking  can  mei  - 
tioned  by  Mettlinger  as  tiittlin  (1473)  and  called  memlin  by  Albertus  Magnus, 
was  provided  with  a nipple  or  a spout,  and  of  varied  shape,  sometimes  simulat  ing 
the  contour  of  the  breast,  sometimes  as  crude  in  form  as  the  pottery  of  primit  i e 
man,  sometimes  resembling  a barrel,  an  hour-glass,  or  a bell.  Spoonfeeding  and 
sucking  cans  are  shown  in  three  16th  century  pictures  in  the  Cologne  museum , 
The  Three  Kings  (H.  Bles),  The  Adoration  of  the  Shepherds  (M.  van  Heemskirck  . 
and  a triptych  of  the  Virgin  by  an  unknown  Frankfort  painter.  The  artifi 
teat  (Zulp  or  Zepflin ) mentioned  in  Mettlinger  (1473)  and  in  Poslin's  Rosegai 


THE  RENAISSANCE  PERIOD 


67 


(1513)  is  figured  in  Albrecht  Diirer’s  “Madonna  with  the  Greenfinch”  of  1506 
■ Kaiser-Friedrich's  Museum,  Berlin),  and  in  a modern  Domestic  Scene  by  J.  G. 
Hantsch  (Leipzig  Museum).  Breast-feeding,  spoon-feeding,  and  can-feeding  are 
all  shown  on  a woodwork  altar  from  St.  Gertrude’s  Church  at  Liibeck  (late  15th 
century,  now  in  the  Liibeck  Museum — Pruning).* 

In  the  Renaissance  period,  much  attention  was  paid  by  the  writers  of  the  time — 
ismus,  Rabelais,  Ascham — to  the  education  and  training  of  children.  Rabelais- 
. particular,  ridiculed  the  time-honored  custom  of  stuffing  a lad  with  dull  book, 


Fig.  5. — St.  Gertrude’s  altar  (15th  century,  showing  breast-feeding,  spoon-feed- 
ing and  bottle-feeding  (Liibeck  Museum).  (From  H.  Briining:  Geschichte  der 
' I thodik  der  Kunstlichen  Sauglingsernahrung,  Stuttgart,  1908,  p.  77.) 

earning,  and  advocated  education  in  the  old  Greek  and  the  modern  sense,  as  a 
deliberate  drawing  out  of  the  latent  faculties  by  the  aid  of  open-air  exercise, 
equitation,  swimming,  archery,  dancing,  etc.  In  England,  among  the  wealthy 
and  the  well-to-do,  this  cult  took  the  peculiar  line  of  sending  the  children  away 
early  to  live  in  the  homes  of  great  nobles  as  pages  and  henchmen,  in  order  to  learn 
the  rules  of  etiquette,  music,  the  theory  of  precedence,  how  to  carve  and  other 
essentials  of  the  training  of  gentlemen  and  gentlewomen.  These  retainers  were 
sometimes  austerely  handled  by  the  great,  and  among  children  sent  to  school  or 
indentured  to  apprenticeship  in  the  trades  and  crafts,  punishments  were  severe 
and  drastic.  Longchamps,  Bishop  of  Ely,  is  said  to  have  pricked  the  sons  of 
nobles  who  acted  as  his  servants,  with  a goad,  “mindful  of  his  grandfather  of 
pious  memory,  who,  being  of  servile  condition  in  the  district  of  Beauvais,  had,  for 
his  occupation,  to  guide  the  plough  and  whip  up  the  oxen.”  Relics  of  this  austere 
preoccupation  with  etiquette  and  good  form  are  to  be  found  in  such  treatises  as 
■ohn  Russell’s  Book  of  Nurture,  Wynkyn  de  Worde’s  Book  of  Kervvnge  (1513), 
The  Book  of  Curtasye  (Sloane  Ms.,  1460),  The  Babees  Boke,  Lerne  or  be  Lewde, 
The  Lytyll  Children’s  Lytel  Boke,  Stans  Puer  ad  Mensam,  the  Birched  School- 
* For  other  pictures,  see  Auvard  and  Pingat,  “ Hygiene  infantile  et  moderne.” 
ris  (1889),  pp.  59-74;  and  H.  Briining,  “ Geschichte  der  Methodik  dei~  kunstlichen 
: ’/jlingsernahrung.”  Stuttgart  (1908),  passim. 


68 


HISTORY  OF  PEDIATRICS 


Boy  (1500),  etc.,  all  which  have  been  preserved  in  F.  J.  Furnivall’s  Early  English 
Meals  and  Manners  (Early  English  Text  Society,  No.  32,  London,  1868). 


THE  SEVENTEENTH  CENTURY 

The  seventeenth  century  was  an  age  of  great  poets  (Shakespeare, 
Milton),  great  dramatists  (Calderon,  Moliere,  the  Elizabethans)  great 
philosophers  (Spinoza,  Bacon,  Locke,  Descartes),  great  painters 
(Velasquez,  Rembrandt),  great  musicians  (Bach,  Purcell)  and  great 
mathematicians  (Newton,  Halley,  Leibnitz).  In  this  age,  the  English 
physician  William  Gilbert  wrote  his  epoch  making  treatise  on  magnet- 
ism (1600),  Harvey  demonstrated  the  circulation  of  the  blood  (1616 — 
28),  the  anatomical  discoveries  following  Vesalius  and  Harvey  were  all 
of  physiological  import,  microscopy  was  founded  by  Kircher,  Hooke, 
Leeuwenhoek,  and  Swammerdam,  histology  by  Malphighi,  physio- 
logical optics  by  Kepler,  Descartes,  Mariotte,  and  Scheiner,  the  physi- 
ology of  digestion  by  Peyer,  Brunner,  and  de  Graaf,  the  physiology 
of  respiration  by  Boyle,  Hooke,  Lower,  and  Mayow,  vital  statistics  by 
Graunt,  Petty,  and  Halley.  Transfusion,  anatomic  injection,  the 
obstetric  forceps,  timing  the  pulse,  and  clinical  thermometry  were 
introduced,  and  internal  medicine  was  represented  by  the  great  name 
of  Thomas  Sydenham. 

In  the  art  of  the  seventeenth  century,  children  play  a prominent 
part,  whether  in  the  wonderful  “Las  Meninas”  of  Velasquez,  Van 
Dyck’s  “Baby  Stuart,”  Rubens’  many  pictures  of  the  charming 
Helena  Fourment  and  her  children,  Rembrandt’s  “Venus  and  Amor” 
(Hendrickje  Stoffels)  and  his  comical  “Ganymede,”  or  Johan  van 
Neck’s  painting  of  a dissection  conducted  by  Dr.  Frederik  Ruysch 
(1683),  in  which  a child  plays  with  an  infantile  skeleton  in  the  corner. 

Infantile  pathology  is  represented  in  the  cretinoid  or  hydro- 
cephalic dwarfs  of  Velasquez,  Ribera’s  portrayal  of  a paralytic  boy, 
Gabriel  Metsu’s  Feverish  Child,  and  the  picture  of  a girl  afflicted  with 
dystrophia  adiposo-genitalis  by  Juan  Careno  de  Miranda.  Rubens 
delighted  in  the  representation  of  healthy,  round-limbed,  laughing 
babies.  His  “ Garland  of  Fruits”  symbolizes,  in  a manner,  the  eugenic 
ideal  of  the  late  Renaissance,  for  the  artists  of  the  period  glorified  the 
state  of  maternity  in  the  full-bodied  woman,  fit  to  be  “the  justified 
mother  of  men.” 

Yet  the  seventeenth  century  was  an  age  otherwise  notable  for 
cruelty  to  children. 

In  an  arret  of  the  Parliament  of  Paris  (September  3,  1667);  it  was 
decreed,  in  the  interests  of  the  special  hospitals,  that  the  grands  seig- 
neurs or  high  officers  of  justice  should  be  held  financially  responsible 
for  the  care  of  all  infants  of  unknown  parentage  found  on  their  lands 
and  taken  to  the  hospitals;  but  the  tight-fisted  nobles  did  not  live  up  to 
their  obligations,  and  the  poor  foundlings  were  shifted  from  place  to 
place  by  those  who  did  not  want  them.  In  Paris,  as  in  ancient  Rome, 
unfortunate  mothers  threw  their  offspring  into  the  sewers,  abandoned 


THE  SEVENTEENTH  CENTURY 


69 


them  at  the  doors  of  hospitals,  or  left  them  in  the  streets  to  die.  The 
laws  were  severe — hanging  for  infanticide,  whipping  and  disgrace 
for  abandonment,  declaration  of  paternity  in  seduction — and  rigidly 
enforced,  but  the  full  penalty  was  paid  by  the  infants  themselves. 


Fig.  6. — Rubens:  The  Garland  of  Fruit  (Diisseldorf  Gallery).  (Eugenic  ideal 
of  the  late  Renaissance  Period). 

Some  children  in  the  crowded  charitable  retreats  were  exposed  anew  or 
drugged  to  death  with  opium  in  order  to  keep  them  quiet;  others  were 
used  as  beggars,  to  make  money,  and  some  were  artificially  malformed 
to  this  end.*  The  extraordinary  number  of  beggars,  professional 
cripples,  blind  and  deformed  persons  held  up  to  ridicule  in  the  etchings 
of  Callot  and  the  paintings  of  the  elder  Brueghel  suggests  that  the 
thematic  material  of  Victor  Hugo’s  “L’homme  qui  rit”  is  not  entirely 
exaggerated.  In  this  novel,  which  deals  with  the  surgical  malforma- 
tion of  a child’s  face  for  political  reasons,  there  is  a chapter  devoted  to 
the  professional  buyers  and  sellers  of  friendless  children  (Jos  cornjrrachi- 
cos),f  a strange  affiliation  of  seventeenth  century  criminals  who,  as  in 
the  later  Roman  Empire,  purposely  lamed  and  maimed  unfortunate 
children  by  a reversed  orthopedic  procedure  (chirurgie  au  rebours). 
According  to  the  romancer,  the  master  of  this  art  of  facial  disfigure- 
ment was  a certain  Dr.  Conquest,  who  wrote  a (perhaps  mythical) 
Latin  treatise  on  the  subject.  A Latin  citation  of  the  procedure  is 
given  from  an  alleged  chapter  “De  Denasatis,”  as  thus:  “ Bucca  fissa 
usque  ad  aures,  genzivis  denudatis,  nasoque  murdridato,  masca  eris,  et 
ridebis  semper”X — the  ideal  of  the  “false-face”  mask  from  time 
immemorial.!  In  some  parts  of  Spain  (Oyarzun,  Urbistondo,  Lesa, 
* Payne,  op.  cit.,  pp.  302-305. 

t Victor  Hugo,  “L’homme  qui  rit.”  Paris  (1869),  Chap.  II. 
t Ibid.,  Bk.  Ill,  Chap.  VI. 

§ The  artificial  production  of  monsters  is  the  theme  of  ‘‘The  Artificial  Change- 
ling” of  John  Bulwer  (1650-  ),  and  is  mentioned  by  Fortunatus  Licetus 

(1577-1657).  See  J.  S.  Billings,  “History  of  Surgery.”  New  York  (1895),  p.  46. 


70 


HISTORY  OF  PEDIATRICS 


Astigarraga),  says  Hugo,  nineteenth  century  mothers  still  intimidated 
their  children  with  the  threat  that  they  would  call  the  comprachicos 
(“ Aguardate,  nino,  que  voy  a llamar  al  comprachicos").  Victor  Hugo 
was  described  by  Sainte  Beuve  as  “the  Frank  energetic  and  subtle, 
who  has  mastered  to  perfection  the  technical  and  rhetorical  resources 
of  the  Latin  literature  of  the  decadence.”  Hugo’s  citations  from 


Fig.  7. — St.  Vincent  de  Paul.  (1576-1660).  From  a statue  in  the  Pantheon, 
Paris,  by  Alexandre  Falguiere.) 

Conquest  may  have  been  mere  literary  supercherie,  but  his  narrative  is 
undoubtedly  true  to  the  spirit,  if  not  to  the  letter  of  the  times,  as 
attested  by  the  endeavors  of  St.  Vincent  de  Paul  (1576-1660).  This 
devout  man,  who  had  once  been  captured  by  pirates  off  Marseilles  and 
sold  into  slavery  himself,  was  the  noblest  champion  of  the  rights  of 
friendless  children  between  Datheus  and  such  men  as  Lord  Ashley, 
Oastler  and  Theophile  Roussel.  In  the  time  of  St.  Vincent  de  Paul,  an 
unknown  woman  of  Paris  began  to  collect  in  her  home  exposed  infants 


THE  SEVENTEENTH  CENTURY 


71 


brought  in  by  gendarmes  at  night.  This  eventually  proved  too  large  a 
charitable  contract  for  one  person.  Many  infants  died  from  lack  of 
food,  or  were  exposed  again  or  turned  over  to  charitable  persons  or 
institutions.  The  two  servants  in  the  establishment  drugged  the 
unfortunates  to  keep  them  quiet,  and  eventually  took  to  selling  them 
to  pedlars  and  mountebanks  ( bateleurs ),  who  in  turn  used  them  for 
money  making  purposes.  Returning  from  one  of  his  missions,  St. 
Vincent  de  Paul  actually  caught  one  of  the  mountebanks  or  comprachi- 
cos,  of  whom  Hugo  speaks,  in  the  act  of  deforming  the  limbs  of  a child 
under  the  walls  of  Paris.  “Barbarian,”  he  cried,  “how  you  deceive 
me — from  the  distance  I took  you  for  a man!”  And  snatching  the 
child,  he  rushed  across  the  city  to  denounce  the  infamy.  He  interested 
a number  of  great  ladies  in  his  cause,  so  that  a small  asylum  was 
established,  which  was  frequently  changed  for  larger  accommodations; 
and  slumming  parties  were  organized  to  gather  in  exposed  waifs. 
Eventually  Louis  XIII  donated  4000  francs  per  annum  to  the  charity, 
and  Anne  of  Austria  8000  francs  after  his  death  (1641).  In  June,  1670, 
the  Foundling’s  Hospital  (Hospice  des  enfans  trouves)  of  Paris  was 
chartered  and  endowed  with  12,000  francs  by  Louis  XIV,  although  its 
actual  annual  expenses  at  that  time  were  40,000  francs.  This  led  to 
the  systematic  conveyance  of  foundlings  to  Paris,  for  the  narrow 
provincial  towns  would  have  none  of  them.  Of  2000  infants 
transported  from  the  provinces  in  this  way,  about  75  per  cent,  died  in 
three  months.  A new  law  was  accordingly  passed  imposing  a fine  of 
1000  livres  upon  any  wagoner  who  brought  in  an  infant  for  purposes  of 
exposure;  and  it  was  decreed  that  abandoned  infants  must  be  taken  to 
the  nearest  hospital  and,  if  necessary,  cared  for  out  of  the  public  funds. 
To  this  day,  Vincent  de  Paul  is  the  patron  saint  of  orphans  and  orphan 
asylums.* * * § 

In  seventeenth  century  England,  the  rate  of  infantile  mortality 
was  also  high. 

In  the  time  of  the  Stuarts,  London  became  overcrowded,  in  spite  of  the  deple- 
tion of  the  population  by  plague,  sweating  sickness,  and  smallpox.  The  rulers, 
from  Elizabeth  to  Cromwell,  opposed  the  building  of  new  houses,  and  the  surplus 
population  sw'armed  to  the  waterside.  “Four- fifths  of  the  population  of  London,” 
says  Forsyth,  “were  crowded  into  the  alleys  and  courts  of  out-parishes  such  as 
Wapping,  St.  Olave’s,  Lambeth,  Whitechapel,  and  Spitalfields.”t  In  conse- 
quence, sometimes  half  the  children  born  in  Restoration  England  died  of  disease. 
Two-fifths  of  the  total  deaths  were  those  of  infants  under  two  years.  In  the  hot 
summers  of  1669-71,  diarrhea  killed  2000  babies  in  eight  or  ten  weeks.  Private 
letters  of  the  period  show  that  the  well-to-do  were  little  better  off.  Traill,  im 
“Social  England”  speaks  of  the  callous  feeling  of  English  parents  for  children  in 
the  Tudor  period.  Lady  Jane  Grey  told  Asham  that  her  child-life  was  such  that 
she  thought  herself  “in  hell.” 4 In  Stuart  England,  boy  and  girl  marriages  were 
encouraged. § The  main  idea  was  to  get  rid  of  children,  by  apprenticeship  among 
the  poor,  by  early  marriages  or  a round  of  visits  among  the  rich.  Suffocation  of 

* Payne,  op.  cit.,  pp.  306-311. 

t D.  Forsyth,  Proc.  Roy.  Soc.  Med.,  London,  iv  (1910-11),  pt.  1,  Sect.  Dis. 
Child.,  p.  117. 

t Traill,  Social  England. 

§ Ibid. 


72 


HISTORY  OF  PEDIATRICS 


the  child  by  overlying  was  sometimes  resorted  to  by  the  unscrupulous.  In  Con- 
greve’s “Love  for  Love”  (act  I,  sc.  1),  produced  in  1695,  a spendthrift  libertine 
says  of  the  mother  of  his  illegitimate  offspring:  “She  knows  my  condition  well 
enough,  and  might  have  overlaid  the  child  a fortnight  ago,  if  she  had  had  any 
forecast  in  her.”  At  birth,  the  newborn  infant  was  salted  (according  to  Galenic 
custom),  tightly  swaddled,  dandled  for  a few  minutes  each  day,  kept  upright  by 
standing  it  up  to  its  armpits  in  a go-cart  and  taught  to  walk  by  means  of  leading 
strings.  The  manual  methods  of  dry-nursing  were  little  known  in  Stuart  England. 
Maternal  and  mercenary  wet-nursing  were  the  rule.  In  the  English  Bills  of 
Mortality,  children  under  two  years  (the  period  of  teething)  are  grouped  apart. 
John  Pechey  (1697)  lowers  the  statutory  period  of  weaning  to  1M~2  years  after 
birth,  i.e.,  not  before  the  child  had  acquired  all  its  teeth.  For  astrological  reasons, 
a child  could  not  be  weaned  at  the  wane  of  the  moon,  but  preferably  when  the 
spring  or  autumn  moon  were  full.  Pap  and  chicken  broth  were  the  earliest 
artificial  foods.  To  get  the  child  accustomed  to  these,  the  mother’s  nipples  were 
smeared  with  wormwood  or  aloes  (Pechey).  When  meat  diet  was  begun,  Pechey 
recommended  that  it  be  “first  chewed  by  the  nurse.”* 

On  the  continent,  dry  nursing  and  hand  feeding  were  well-known.  The  child 
was  fed  from  pitchers,  bowls,  and  glasses  of  varied  shape,  such  as  that  seen  in 
Adriaen  Brouwer’s  “Baby  drinking  from  a Glass”  (Leipzig  Museum)  or  the  “Fam- 
ily of  Fauns”  of  Jordaens  (Nuremberg). 

The  Seventeenth  Century  was  an  age  of  individualism  in  thought 
and  research  and  was  more  remarkable  for  monographs  on  special 
subjects  than  for  exhaustive  treatises.  It  was  the  age  of  the  Arbeit 
rather  than  of  the  text-book. 

Among  the  twenty  pediatric  treatises  or  tracts  listed  by  Meissner  are  those  of 
Mario  Zucarri  (Naples,  1604),  Joh.  Ceckius  (Wittenburg,  1604),  Jacques  Guille- 
meau  (Paris,  1609), f Johan  Hucher  (Cologne,  1610),  F.  P.  Cascalis  (Madrid,  1611), 
Amthor  ( Nasocomium  infantile  et  puerile,  Schleussing,  1638),  James  Primrose 
(Rotterdam,  1658),  Walter  Harris  (London,  1689),  Philip  Grilling  (Nordhausen, 
1660),  Ettmueller  (Leipzig,  1675),  Christian  Lamperti  (Merseburg,  1689),  Jero- 
ijimo  Soriano  (Saragossa,  1690),  John  Pechey  (London,  1697)  and  J.  J.  Loew 
(Nuremberg,  1699).  There  is  much  of  pediatric  interest  in  the  Maaseh  Tuviah 
of  Tobias  Katz  (1652-1729),  which  has  been  described  by  Levinson,  J Of  these, 
however,  only  one  need  detain  us,  the  De  morbis  acutis  infantum  of  Walter  Harris, 
which  became  so  well-esteemed,  that  even  in  the  middle  of  the  eighteenth  cen- 
tury, it  was  described  as  “the  best  that  was  ever  written  on  the  acute  diseases 
of  infants.” 

Walter  Harris  (1647-1732),  of  Gloucester,  England,  was  elected 
fellow  of  New  College  Oxford  in  1666  and  took  his  baccalaureate 
degree  in  1670.  Joining  the  Church  of  Rome,  he  resigned  his  fellow- 
ship and  went  to  study  medicine  in  France,  taking  his  iM.D.  at 
Bourges  in  1675.  Commencing  practice  in  London  in  1676,  the  edict 
of  1678  compelled  him  to  recant  his  Catholic  professions,  after  which 
he  was  received  M.D.  at  Cambridge.  He  became  an  F.R.C.P. 
in  1682,  was  twice  Harveian  orator  (1699,  1707),  treasurer  (1714-17) 
and  delivered  the  Lumleian  lectures  at  the  College  of  Physicians  during 

* Traill,  op.  cit.,  pp.  116-120. 

f For  a detailed  account  of  the  pediatric  treatises  of  Ceck  (1603)  Ferrarius 
(1604),  Jacques  Guillemeau  (1909),  James  Primrose  (1659),  John  Pechey  (1696) 
and  others,  the  reader  is  referred  to  G.  F.  Still’s  essay  in  the  Osier  Anniversary 
Volumes,  New  York  (1919).  1,  177-191. 

J A.  Levinson,  Bull.  Soc.  Med.  Hist.  Chicago,  II  (1917—19),  pp.  110-11S. 


THE  SEVENTEENTH  CENTURY 


73 


1714-17.  He  became  physician-in-ordinary  to  Charles  II  (1683) 
and,  after  the  Revolution,  physician  to  William  III,  attending  Queen 
Mary  in  her  last  illness  (1694).  He  accompanied  King  William 
to  Holland,  and,  while  there,  published,  at  Amsterdam,  his  treatise 
on  the  Acute  Diseases  of  Infancy  (1689),  which  was  reprinted  in  1705, 
1720,  1736,  1741,  1745,  translated  into  German  (1691),  French  (1738) 
and  twice  into  English  (1742),  holding  the  field  until  it  was  supplanted 
by  the  English  treatise  of  Michael  Underwood  (1784).  It  is  not 
strange  that  the  best  pediatric  treatise  of  the  seventeenth  century  was 
inspired  and  patronized  by  its  greatest  clinician.  Harris  was  a friend 
and  protege  of  Sydenham,  who  once  advised  him  to  read  Don  Quixote 
in  lieu  of  medical  studies.  He  was  far  behind  Sydenham  in  capacity 
for  clinical  observation,  but,  he  quotes,  with  pardonable  vanity,  an 
utterance  of  his  master:  “I  think  your  little  book  may  be  of  more 
service  to  the  public  than  all  my  own  writings.”  The  pathology  of 
Sydenham  was  the  old  Hippocratic  pathology  of  coction  of  the  humors 
and  discharge  of  the  materies  morbi;  but  Harris  affected  the  acid  dia- 
thesis of  Franciscus  Sylvius,  viz.,  that  “all  the  symptoms  of  gastro- 
intestinal disorders  owe  their  origin  to  acid  products  in  the  body” 
( Abt) . 

Following  the  Hippocratic  reasoning  that  diseases,  different  in  different  locali- 
ties, are  of  but  one  species  with  one  universal  cause,  Harris  reasons  that  children’s 
diseases  are  due  to  the  moisture  of  their  constitution  (“puerile  humidity”),  which 
“is  not  apt  to  degenerate  into  any  putrefaction  but  the  acid.”  Acid  eructations, 
acid  stools  abound  in  infancy,  and  milk  itself  turns  sour  and  coagulates  when 
heated.  “All  the  symptoms  of  infants  owe  their  origin  to  an  acid,  as  their  legiti- 
mate parent.”  The  concept  of  infancy  is  extended  beyond  Galen’s  three  months 
to  the  fourth  year,  childhood  extending  to  fourteen.  Infants  fall  sick  spon- 
taneously and  are  as  easily  cured.  The  directions  for  diagnosis,  as  derived  from 
the  nurse’s  observations,  are  admirably  paragraphed.  Our  author  dilates  on  the 
“procatartic  cause,”  i.e.,  hereditary  taints  in  the  parents,  the  depraved  appetites 
of  pregnancy,  coition  during  pregnancy,  and  maternal  impressions.  Other 
immediate  causes  of  infantile  diseases  are  catching  cold,  thickness  of  breast  milk, 
the  dangers  of  mercenary  wet-nurses,  and  giving  infants  meat  and  wine.  Wine  is, 
however,  recommended  for  English  girls  at  the  appearance  of  the  menses,  even 
before  the  Galenic  fourteenth  year.  Disordered  digestion,  rashes,  gripes,  flatu- 
lence, constipation,  vomiting,  green  stools,  fever,  convulsions,  thrush  at  teething, 
are  all  attributed  to  acidity,  “the  tragedy  in  the  lower  belly.” 

Fever  in  children  is  “an  increase  of  the  natural  heat.”  Lean  and  scrawny 
infants  are  most  liable  to  nervous  fevers;  fat  infants  abounding  with  phlegm,  with 
soft  heads,  are  liable  to  rickets,  whooping  cough,  thrush  and  King’s  Evil;  children 
born  of  sickly  hysterical  mothers,  to  depraved  appetites.  Harris  sharply  scores 
the  poor  therapeutic  resources  of  his  contemporaries,  who  follow  the  beaten  track 
of  the  ancients.  Even  his  pattern,  Sylvius,  is  denounced  as  “the  opiate  doctor.” 
He  ridicules  chemical  therapeutics  as  imposing  “the  impenetrable  hardness  of 
metals”  upon  “the  waxen  softness  of  the  infantile  constitution.”  “Mindful  of 
acidity,”  he  upholds  Sydenham’s  practice  of  purging  in  fevers,  but  opposes  the  use 
of  sudorifics  (diaphoretics).  His  recommendation  of  “testaceous  powders” 
(oyster  shells,  crab’s  eyes  and  claws,  pearls,  coral,  prepared  chalk,  Goa  stone,  etc.) 
as  anodynes  and  “absorbents  of  acid”  held  its  own  in  English  practice  for  over  a 
century.  A series  of  shell-powders  and  pearl  juleps  is  listed.  Rhubarb  is  better 
than  aloes  for  infants.  Cream  of  tartar  must  be  unadulterated.  Bloodletting 
is  only  of  use  in  convulsive  coughs  or  fevers  with  cough.  The  exhibition  of  opiates 
is  only  permitted  in  obstinate  vomiting.  The  Turkish  practice  of  giving  lemon 


74 


HISTORY  OF  PEDIATRICS 


juice  in  plague  and  malignant  fevers  is  praised.  Teething,  thrush,  vomiting, 
diarrhea,  convulsions,  smallpox,  are  all  to  be  treated  by  “testaceous  medicines.” 
The  work  closes  with  a series  of  clinical  cases,  illustrating  this  theory.  Throughout 
the  entire  book,  semeiology  is  presented  in  a free-hand  manner,  evidently  intended 
for  popular  consumption.  Walter  Harris  resembles  Galen  in  his  vanity  about 
successful  cures.  His  treatise  on  the  venereal  disease  anticipates  some  of  the 
historical  views  of  Sudhoff. 

The  treatise  of  Harris  is  really  a racy  argument  in  favor  of  a certain 
theory  of  disease  and  a certain  line  of  treatment.  A far  greater  name 
in  the  history  of  pediatrics  is  that  of  Francis  Glisson  (1597-1677),  or 
Rampisham  (Dorsetshire),  who  described  the  hepatic  capsule  investing 
the  portal  vein  (1654),  employed  suspension  in  spinal  deformities 
(1660),  introduced  the  concept  of  “ irritability ” as  a property  of  all 
living  tissues  (1677)  and  gave  the  original  and  classical  account  of 
rickets  and  its  association  with  infantile  scurvy  in  his  “De  rachitide” 
(1650).*  Rickets,  first-  mentioned  in  the  London  Bills  of  Mortality  in 
1634,  was  first  described  in  Daniel  Whistler’s  “De  morbo  puerili 
Anglorum”  (1645), f and  further  in  a tract  of  John  Mayow  (1669),  and 
in  some  12  inaugural  dissertations  listed  by  Meissner  (pp.  134-135). 

In  the  pediatric  handbook  (1609)  of  Jacques  Guillemeau  (1550- 
1612),  which  contains  a strong  brief  for  material  breast-feeding,  the 
dependence  of  kyphosis  and  bending  of  the  ribs  upon  faulty  nutrition 
is  already  recognized  even  though  the  condition  is  not  labelled 
(G.  J.  Still).  The  de  morbis  infantum  (1674)  of  Franciscus  Sylvius 
(1614-72),  the  fourth  book  of  his  Praxis  Medica,  and  translated  into 
English  by  Richard  Gower  (1682),  illustrates  the  ideas  of  Sylvius  about 
gastro-intestinal  acidity  as  the  cause  of  infantile  disease.  The  only 
new  feature  is  “green  stone  with  gripes,”  the  green  scour  of  Chevne. 

Of  original  clinical  contributions  bearing  upon  pediatrics,  Tobias  Cober  noted 
the  relation  between  typhus  fever  and  pediculosis  (1606),  Andre  de  Laurens 
maintained  the  contagiousness  of  scrofula  (1609),  Felix  Platter  first  described 
“thymus  death”  (1614),  Francois  Citois  described  “Poitou  (lead)  colic”  (1616), 
Daniel  Sennert  (1626)  and  Sydenham  (1675)  described  scarlatina,  the  latter  giving 
the  disease  its  name,  Hofer  described  cretinism  (1657),  Jacob  Bontius  beriberi 
(1642)  and  Porchon  described  Rotheln  as  “the  purples”  (1698). 

The  great  Sydenham  left  classical  accounts  of  many  diseases,  notably  broncho- 
pneumonia, pleuropneumonia,  dysentery  (1672),  measles  (1675),  hysteria  (1682) 
and  chorea  minor  (1686),  and  paid  particular  attention  to  children’s  diseases  in  his 
writings. 

C.  V.  Schneider  (1660)  and  Richard  Lower  (1672)  showed  that  the  nasal 
secretions  ( pituita ) come  not  from  the  brain  (as  hitherto  supposed)  but  from  the 
Schneiderian  membranes. 

Swammerdam  demonstrated  that  the  foetal  lungs  will  float  after  respiration 
(1667),  which  medico-legal  test  was  successfully  applied  in  a court-room  case  of 
infanticide  by  Johan  Schreyer  (1681). 

* See  Glisson,  “De  rachitide.”  London  (1650),  pp.  285-286,  or  the  English 
translation,  London  (1668),  pp.  249-250. 

f Norman  Moore  (in  St.  Barth.  Hosp.  Rep.,  London,  xx  (1SS4),  pp.  71-82)  shows 
that  Whistler’s  essay,  while  antedating  Glisson’s  by  five  years,  is  really  based  on 
second-hand  information  obtained  from  Glisson  himself,  and  is  otherwise  valueless. 
Gee  has  shown  that  the  Flagellum  Anglise  of  Garancier  (London,  1647)  contains 
nothing  on  rickets. 


THE  EIGHTEENTH  CENTURY 


75 


The  seventeenth  century  literature  of  special  monographs  on  pediatrics  is 
considerable.  Meissner  lists  18  titles  on  infant  nutrition,  69  on  monsters,  2 on 
infantile  jaundice,  6 on  aphthae,  25  on  infantile  atrophy,  5 on  dentition,  29  on 
intestinal  worms,  8 on  hydrocephalus,  7 on  scrofula,  Rolfinck  (1637)  and  Wedel 
(1684)  on  gibbous  spine,  3 on  club-foot,  and  114  on  smallpox. 

During  the  seventeenth  century,  the  plague,  leprosy,  typhus  and  typhoid  fever, 
smallpox,  influenza,  and  dysentery  were  more  or  less  pandemic  at  intervals,  and 
swept  away  thousands.  Influenza  was  first  reported  in  America  in  1647  (Jacobi). 
Diphtheria  was  confined  to  Spain  and  Italy.  The  first  American  case  occurred  at 
Roxbury,  Massachusetts,  in  1659  (Jacobi).  Yellow  fever  appeared  in  New  York 
in  1668,  but  did  not  reach  Europe  until  the  18th  century.  Smallpox  broke  out  in 
Pennsylvania  in  1661  and  in  Charleston,  S.  C.  (1699).  Infantile  conjunctivitis 
was  first  reported  in  America  in  1658  (Jacobi). 


THE  EIGHTEENTH  CENTURY 

In  the  eighteenth  century,  the  age  of  theorists  and  systematists, 
clinical  pathology  was  founded  by  Morgagni  and  Matthew  Baillie, 
experimental  and  pathological  surgery  by  John  Hunter,  preventive 
inoculation  by  Jenner,  improved  clinical  and  instrumental  diagnosis 
by  Auenbrugger,  Martine,  and  Currie,  public  hygiene  by  Frank, 
electrophysiology  and  electrotherapy  by  Galvani  and  Volta;  embryol- 
ogy by  Wolff,  medical  bibliography  by  Haller.  The  age  was  remark- 
able for  clinicians  of  essentially  practical  type,  and  pediatrics,  as  a part 
of  internal  medicine,  was  consequently  forward.  The  most  prominent 
pediatrists  of  the  eighteenth  century  were  Friedrich  Hoffmann,  Rosen 
von  Rosenstein,  Armstrong,  Raulin,  Underwood,  Mellin,  and  Struve. 
The  pediatric  literature  of  this  period  is  marked  by  original  clinical 
observations  from  actual  case  histories,  with  an  occasional  eye  to 
morbid  anatomy. 

Friedrich  Hoffmann  (1660-1742),  of  Halle,  a medical  graduate  of  Jena  (1682), 
and  one  of  the  most  highly  esteemed  physicians  and  medical  theorists  of  his  time, 
published  a Praxis  clinica  morborum  infantum  in  1715,  which  was  translated  into 
German  (1741)  and  followed  by  another  treatise  on  the  principal  diseases  of  infants 
(1747).  Hoffmann  also  left  original  contributions  on  infantile  atrophy  (1702), 
mesenteric  fever  (1728),  chlorosis  (1730),  whooping  cough  (1732),  intestinal 
worms  (1734),  diseases  of  the  foetus  in  utero  (1738),  and  was  one  of  the  first  to 
describe  rubella  (1740). 

Nils  Rosen  von  Rosenstein  (1706-73),  born  near  Gothenburg, 
Sweden,  on  February  1,  1706,  being  intended  for  the  ministry,  studied 
medicine  in  secret,  against  the  will  of  his  father,  and  after  working  and 
teaching  for  eight  years,  followed  by  three  years  of  extensive  travel,  he 
received  his  medical  degree  at  Hardwick  (1731).  Attaching  himself 
to  the  University  of  Upsala  as  a teacher,  he  succeeded  Rudbeck  as 
professor  of  anatomy  and  natural  history  in  1740,  later  filling  also  the 
chairs  of  physiology  and  practice,  with  clinical  teaching  at  the  bedside. 
In  1756,  he  retired  to  private  practice  in  Stockholm,  and  died  July  16, 
1773.  He  was  physician  to  the  king  (1735)  and  archiater  (1745), 
became  a member  of  the  Swedish  Academy  of  Sciences  (1739)  and  was 
ennobled  in  1762.  In  his  travels,  Rosenstein  had  met  all  the  medical 
celebrities  of  his  time,  and  his  ability,  rare  experience,  and  amiable 


76 


HISTORY  OF  PEDIATRICS 


disposition  made  him  widely  known  as  one  of  the  best  physicians  of 
his  period. 

He  published  a compendium  of  anatomy  in  Swedish  (1738),  a treatise  on  domes- 
tic medicine,  after  the  fashion  of  Tissot’s  Avis  au  Peuple,  and  some  50  Latin 
dissertations  on  the  most  varied  subjects,  such  as  the  recording  of  clinical  eases 
(1728),  purification  of  water  (1736),  errors  in  prescribing  (1737),  equitation  (1738), 
incipient  phthisis  (1740),  gastritis  (1740),  the  possibilities  of  plastic  surgery  (1742, 
smallpox  (1751-4)  and  infantile  epilepsy  (1754),  but  his  greatest  work  is  his 
treatise  on  children’s  diseases  (1764),*  which  was  preceded  by  a dissertation  on 
infantile  diseases  (1754).  The  pediatric  treatise  was  reissued  in  1761  and  1771  and 
was  translated  into  German  (1766),  Dutch  (1768),  English  (1780)  and  French 
(1780).  The  German  translation  passed  through  six  editions.  Rosenstein  de- 
scribed the  first  epidemic  of  scarlatina  in  Sweden  (1742-3),  also  the  symptoms  of 
hyoscyamus  poisoning  in  a boy  (1744),  in  which  he  was  the  first,  after  Galen,  to 
call  attention  to  mydriatics.  In  the  edition  of  1771,  Rosenstein’s  treatise  consists 
of  28  chapters,  the  first  on  wet-nursing,  the  rest  on  costiveness,  prolapsus  ani  and 
other  infantile  disorders.  Pneumatocele,  inoculation  of  smallpox,  inoculation  of 
measles,  scarlet  fever,  whooping  cough  (chin  cough),  ague,  croup,  venereal  disease, 
and  vermin  are  the  new  subjects  featured.  It  is  maintained  that  a child  should  be 
suckled  on  its  mother’s  own  milk,  as  alien  milk  may  make  it  sick.  Lactation  is 
held  to  relieve  mothers  of  milk  fever  and  leucorrhea.  If  a wet-nurse  is  employed, 
she  must  be  free  from  diathetic  or  venereal  disease.  The  sucking-bottle  (biberon), 
if  used  at  all,  must  be  kept  clean.  The  nurse  should  be  purged  with  suppositories 
of  honey  and  olive  oil,  as  active  purges  will  injure  the  child  through  the  milk. 
Violent  emotions  in  the  nurse  will  produce  convulsions  in  the  child.  The  breast 
should  not  necessarily  be  given  when  the  child  cries,  but  only  when  its  eyes  sparkle 
with  anticipation.  A modern  note  is  the  warning  against  the  neglect  of  diarrheas 
falsely  attributed  to  teething,  and  the  insight  into  the  harmful  effects  of  over- 
feeding (Heubner).  Swaddling  is  condemned.  Nursing  by  the  fire-side  is 
dangerous  (burns  and  CO  poisoning).  Rosenstein  never  saw  a tongue-tied 
child.  Snipping  of  the  frenum  is  to  him  a nurse’s  trick.  Violent  rocking  causes 
indigestion  and  vomiting.  The  meconium  is  to  be  purged  out  by  an  artificial  nipple 
steeped  in  manna  and  sugar.  Gripes  must  be  speedily  treated,  lest  they  cause 
convulsions.  In  teething,  the  brains  of  a hare  or  other  animal  remedies  are 
ridiculed,  and  a wolf’s  tooth  is  no  better  to  bite  upon  than  crystal  or  other  hard 
substance.  The  different  diseases  and  their  treatment  are  given  in  great  detail. 
No  less  than  fourteen  different  species  of  diarrhea  are  described.  The  Chinese  and 
Circassian  methods  of  inoculating  against  smallpox  are  given,  also  the  folk- 
custom  of  “buying  the  smallpox.”  Rosenstein  used  a preservative  pill  of  calomel, 
camphor,  aloes,  and  guaiac.  The  general  technique  of  inoculation  occupies  a 
chapter  of  35  pages.  Francis  Home’s  experiments  on  inoculating  against  measles 
are  praised.  The  true  cause  of  smallpox  and  whooping  cough  is  “some  heter- 
ogenous matter  or  seed,  which  has  a multiplicative  power.”  Immunity  after  an 
attack  is  noted.  Water-drinking  (especially  the  mineral  water  at  Satra)  and 
eating  fish  or  raw  ham  may  cause  helminthiasis.  The  history  of  infantile  rickets 
and  of  infantile  cramp  in  Sweden  is  detailed,  with  many  case  histories.  The  work 
abounds  in  statistical  observations  and  reasoning  drawn  from  the  Swedish  bills 
of  mortality. 

William  Cadogan  (1711-97)  of  London,  a Leyden  graduate  of  1737, 
who  became  an  army  surgeon,  made  a wide  reputation  by  his  “Essay 
on  the  Nursing  and  Management  of  Children”  (1750),  which  passed 
through  10  editions,  and  his  Dissertation  on  Gout  (1771). 

The  pediatric  essay  is  well  written,  full  of  sound  sense,  did  much  to  substitute 
loose  clothing  for  swaddling  and  was  a strong  argument  in  favor  of  maternal 

*Rosen  von  Rosenstein,  Underrattelser  om  bam-sjukdomar  och  deras  bote 
medel.  Stockholm,  1764. 


THE  EIGHTEENTH  CENTURY 


77 


nursing  against  the  spoiling  of  the  child’s  stomach  with  panada,  caudle,  sugared 
and  spiced  paps  and  bread  adulterated  with  alum.  Magnesia  alba  is  preferred 
to  the  pearl  and  chalk  juleps  of  Harris.  Sensible  directions  for  exercise  are  given. 

In  1767,  George  Armstrong,  a London  pediatrist,  published  “An 
Essay  on  the  Diseases  most  fatal  to  Infancy,”  which  passed  through 
three  editions  (1771, 1777, 1778)  to  be  enlarged  by  A.  P.  Buchan  in  1808. 
In  1769,  Armstrong  established  the  first  pediatric  hospital  in  England, 
a Dispensary  for  Poor  Children,  which  was  discontinued  in  December, 
1781,  from  lack  of  financial  support.  It  was  the  only  institution  in 
which  the  children  of  poor  parents  were  received  without  letters  of 
admission,  in  cases  of  desperate  illness.  During  the  twelve  years  of  its 
activity,  35,000  children  were  admitted  and  treated.  Armstrong 
published  an  account  of  his  Dispensary  in  1772,  but  his  philanthropy 
went  unrewarded.  He  died  in  obscurity. 

His  “Essay”  is  a good  example  of  the  judicious,  common-sense  clinical  observa- 
tion of  the  English  practitioner  of  the  time.  He  notes  the  neglect  of  pediatrics 
in  his  period,  the  common  byword  being  that  “The  best  doctor  for  a child  is  an  old 
woman.”  Even  John  Hunter  maintained  that  nothing  can  be  done  for  children 
when  they  are  ill.  Armstrong  denounces 
the  common  neglect  of  children’s  diseases, 
both  by  parents  and  practitioners,  par- 
ticularly the  impotent  plea  that  children 
cannot  tell  of  their  ailments  and  doctors 
are  incompetent  to  prescribe  for  them. 

He  describes  20  infantile  diseases,  omit- 
ting the  acute  fevers  for  lack  of  ripened 
personal  experience  with  them.  He 
makes  much  of  “inward  fits”  (wind- 
colic)  and  the  hectic  fever  of  teething  as 
new  diseases.  Constipation  is  “dry 
gripes”  and  diarrhea  (cholera  infantum) 

“watery  gripes.”  The  chapter  on 
hydrocephalus  interims  contains  three 
cases,  successfully  treated,  by  Matthew 
Dobson,  John  Hunter,  and  Armstrong. 

Separate  chapters  are  devoted  to  oph- 
thalmia, lippitudo  (blear-eyes),  leucoma 
and  tumors  after  smallpox,  and  there 
is  a chapter  on  the  treatment  of  incipient 

cataract.  The  chapter  on  scrofula  em-  pIG  g Robert  Whytt.  (1714-66). 

phasizes  the  value  of  sea-air  and  sea-  (Courtesy  of  Dr.  John  Ruhrah, 

bathing  for  city  children  and  of  a dry  Baltimore.) 
inland  climate  for  scrofulous  children 

from  the  coast.  Armstrong’s  favorite  remedy  is  “a  milk  puke  of  antimonial 
wine.”  He  upholds  the  practice  of  emesis  in  infantile  complaints,  but  urges 
that  the  bowels  should  be  evacuated  before  emesis.  The  importance  of  early 
exercise  as  a preventive  of  infantile  disease  is  emphasized,  the  work  winding  up 
with  some  rules  on  nursing.  He  first  described  congenital  pyloric  stenosis  (1777). 

In  the  same  year  in  which  Armstrong’s  Essay  appeared,  Robert 
Whytt  (1714-66)  of  Edinburgh,  eminent  in  the  physiology  of  the  brain 
and  spinal  cord,  published  his  “Observations  on  the  Dropsy  in  the 
Brain”  (1768),  which  contains  the  classical  account  of  tuberculous 
meningitis. 


78 


HISTORY  OF  PEDIATRICS 


Some  features  of  this  disease  had  been  vaguely  noted  by  the  ancients.  Thomas 
Willis  observed  the  placques  and  tubercles  (1682);  Petit  confused  acute  and  chronic- 
hydrocephalus  (1718);  Boissier  de  Sauvages  gave  a good  description  (1763);  but 
Whytt’s  jcount- individualized  the  clinical  picture,  and  nothing  further  was  done 
until  Senn  of  Geneva  located  the  lesion  in  the  pia  mater,  calling  the  disease  men- 
ingitis (1825),  W.  W.  Gerhard  established  its  tuberculous  nature  (1834)  and  Rilliet 
and  Barthez  completed,  in  1843,  the  differential  diagnosis  (Ruhrah).* 

In  the  same  year,  Joseph  Raulin  (1708-84),  a provincial  French  practitioner 
who  came  up  to  Paris  about  1750,  published  a two-volume  treatise  on  the  con- 
servation of  infancy  (1768),  which  was  reissued  in  three  volumes  in  1779,  and  is  now 
valued  highly  for  its  historic  sidelights  on  the  methods  of  dry-nursing. 

Michael  Underwood  (1736-1820),  of  Surrey,  England,  studied  at 
St.  George’s  Hospital  (London)  under  Caesar  Hawkins,  saw  something 
of  the  practice  of  John  Freke,  and  finished  his  medical  education 
in  Paris.  He  practised  surgery  in  Great  Marlborough  Street,  and 
after  admission  as  licentiate  of  midwifery  at  the  College  of  Physicians 
(1784),  became  attached  to  the  British  Lying-in  Hospital,  and  attended 
the  Princess  of  Wales  at  the  birth  of  Princess  Charlotte  (January  7, 
1796).  He  was  the  last  “man  midwife.”  In  1783-8,  he  published  a 
treatise  and  some  surgical  tracts  on  ulcers  of  the  legs,  and,  in  1784  his 
“Treatise  on  the  Diseases  of  Children.”  This  book  took  the  place  of 
Walter  Harris’s  treatise  and  passed  through  several  editions,  the  last 
being  much  enlarged  by  John  Bell  and  Marshall  Hall  (1842). 

The  first  edition  contains  the  earliest  account  of  poliomyelitis.  The  book, 
dedicated  to  the  Queen,  is  written  for  the  laity  as  well  as  the  profession.  Technical 
terms  are  avoided.  Our  author  apologizes  for  his  prolixity  of  style,  preferring  to 
make  his  meaning  plain  even  at  the  expense  of  concision.  He  laments  the  neglect 
of  the  study  of  infantile  diseases,  and  that,  in  the  past,  “little  more  had  been 
attempted  than  getting  rid  of  the  wild  prejudices  and  anile  prescriptions  of  the 
older  writers.”  The  dangers  of  high  infantile  mortality  to  the  body  politic  are 
already  signalized.  Underwood  combats  Armstrong’s  idea  of  giving  an  emetic  to 
evacuate  the  meconium  and  his  general  preference  for  antimonial  wine  over  the  chalk 
juleps  and  absorbent  powders  of  Walter  Harris.  The  new  disorders  described  are 
those  arising  from  malformations  of  the  heart,  “red  gum,”  milk  blotches  (erusta 
lactacea),  “skin  bound”  (sclerema,  the  taut,  waxy  cold  skin  of  Andry  and  Tenon), 
mesenteric  fever,  marasmus,  cardialgia,  chicken-pox  (Heberden),  spasmodic  cough, 
seven-days  disease  (tropical  convulsions),  shingles,  ringworm,  cataract,  sty, 
deafness,  gangrenous  erosion  of  the  cheeks,  psoas  abscess,  Pott’s  disease,  polio- 
myelitis, whitlow,  boils,  chilblains,  burns  and  scalds,  tongue-swallowing,  epistaxis, 
umbilical  hemorrhage,  hydrocele,  retained  testis,  tumefaction  of  the  prepuce, 
vaginal  discharges,  poisonous  bites,  hernia  cerebri,  tumors  of  the  scalp,  spina 
bifida,  harelip,  and  nagvus.  Ranula,  siriasis,  macies  and  other  diseases  of  the  older 
writers  are  reviewed,  and  the  chapters  on  luxations  and  fractures,  varus  and  valgus 
in  children  are  the  first  after  Felix  Wiirtz.  The  book  concludes  with  a chapter  on 
nursery  hygiene,  or  the  “non-naturals”  (food,  air,  sleep,  etc.),  including  directions 
for  reviving  still-born  infants,  the  necessity  of  hardening  by  inuring  to  cold,  and  the 
need  for  definite  exercise  in  infants.  The  concluding  section  on  the  “passions  of 
of  the  mind”  is  an  early  essay  in  infant  psychology. 

A remarkable  medical  polyhistorian  of  the  Old  Vienna  School  was  Joseph 
Jakob  von  Plenk  (1738-1807),  who  wrote  systematic  treatises  on  obstetrics 
(1769),  surgery  (1769-83),  anatomy  (1776),  dermatology  (1776),  ophthalmology 
(1777),  dentistry  (1778),  bromatology  (1784),  toxicology  (1785),  botany  (17SS-9S), 

* J.  Ruhrah,  Med.  Library  & Hist.  Jour.,  Brooklyn,  ii  (1904),  pp.  153-165, 
port. 


THE  EIGHTEENTH  CENTURY 


79 


pharmacy  (1799-84)  and  pediatrics  (1807).*  His  Doctrina  contains  a good 
classification  of  infantile  diseases,  treats  of  asphyxia  neonatorum,  chorea,  tabes 
dorsalis,  gonorrhea,  infantile  syphilis,  pediculosis,  malocclusion  (dentitio  obliqua), 
a id  many  other  complaints  in  remarkably  terse  paragraphs,  with  many  prescrip- 
dons,  concluding  with  a plate  of  a deaf  and  dumb  alphabet.  Plenk’s  books,  any 
of  them,  would  be  a treasure-trove  for  medical  examiners  in  easy  Latin.  He  made 
a reputation  by  treating  infantile  syphilis  with  “mercury-gum,”  a suspension  of 
ercury  in  gum  arabic. 

Gerhard  van  Swieten  (1700-1772),  leading  physician  of  the  Old  Vienna  School, 
ir  his  Commentaries  on  Boerhaave’s  Aphorisms  (1743),  contributed  notably  to  the 
rational  pediatrics  of  his  time,  particularly  in  regard  to  the  care  and  hygiene  of 
fancy.  A miscellaneous  author  of  the  same  type,  but  less  profound,  was 
hristoph  Girtanner  (1760-1800)-,  of  St.  Gall,  Switzerland,  a vain,  disputatious  and 
mewhat  superficial  writer,  who  was  one  of  the  opponents  of  the  Brunonian 
eory  of  disease,  and  the  author  of  a three-volume  historical  essay  on  venereal 
useases  (1783-9).  He  published  (1794)  an  essay  on  children’s  diseases,!  which, 
in  the  opinion  of  contemporary  pediatricians,  is  showy  and  specious.  Christoph 
Jakob  Mellin  (1744-1817),  a Jena  graduate  of  1766,  published  on  account  of  the  epi- 
[emic  of  whooping-cough  at  Langensalza  in  1768-9  (1770),  and  a pediatric  treatise 
Der  Kinderarzt  (1787).  The  famous  Christoph  Wilhelm  Hufeland  (1762-1836), 
o.i  Berlin,  published  two  tracts,  addressed  to  mothers,  on  the  hygiene  and  physical 
education  of  children  (1794-9)  and  a treatise  on  the  hygiene  and  diseases  of  the 
fe  tus  in  utero  (1827).  A Handbook  of  Children’s  Diseases,  for  parents  and 
preceptors,  was  published  by  Christian  August  Struve  (1767-1807),  of  Gorlitz, 
ii  1797. 

The  pioneer  of  school-hygiene  was  the  celebrated  Johann  Peter  Frank  (1745- 
1821),  in  his  “Complete  System  of  Medical  Polity”  (1777-88),  the  first  systematic 
eatise  on  public  hygiene,  which  contains  separate  chapters  on  the  hygiene  of 
■fancy,  lactation,  wet-nursing,  foundling  asylums,  the  overtaxing  of  childhood 
id  the  hygiene  of  education.  The  chapter  on  school-hygiene  contains  praeti- 
lly  everything  brought  out  later  by  Virchow  and  Hermann  Cohn.  The  proper 
lighting,  heating  and  ventilation  of  the  school-room,  the  proper  slanting  and 
■ ljustment  of  desks  and  benches  in  relation  to  visual  requirements,  are  all  features 
4 this  wonderful  book. 

The  miscellaneous  literature  of  pediatrics  in  the  eighteenth  century  is  extensive 
a.  id  difficult  to  classify.  The  reader  is  referred  to  the  arrangements  by  subjects 
in  Meissner’s  sterling  bibliography.  Nearly  every  important  physician  of  the 
period  wrote  something  on  pediatric  subjects.  Stahl  wrote  on  the  requisites  of  a 
good  wet-nurse  (1698),  worms  (1698),  ascites  (1702),  diseases  of  children  (1705), 
n edical  gymnastics  (1708),  smallpox  and  measles  (1709)  and  cachexia  (1710); 
Haller  on  monsters  (1745-53),  spinal  deformities  (1748-9)  and  congenital  hernia 
(1749);  Roederer  on  smallpox  (1756),  apparent  death  (1760),  infantile  atrophy 
1758),  taenia  (1760)  and  rickets  (1788);  Joh.  Peter  Frank  on  education  (1766), 
rickets  (1788)  and  gastric  fever  (1799);  Wrisberg  on  fetal  respiration  (1763),  mon- 
ers  (1791-9),  undescended  testicles  (1799),  apparent  death  (1780)  and  inoculation; 
Baumes  on  convulsions  and  colic  (1781),  epidemic  jaundice  (1788-1806),  and 
crofula  (1789-1805). 

In  1774-6,  Hugh  Downman  (1740-1809),  a physician  of  Exeter,  England, 
iblished  “Infancy:  a Poem,”  in  three  parts,  which  was  reprinted  several  times 
down  to  1809. 

The  literature  of  smallpox,  variolation  and  vaccination  is  enormous.  In  the 
period  preceding  the  publication  of  Jenner’s  Inquiry  (1798),  variolation  or  inocula- 
tion, introduced  from  the  Orient  by  Timoni  (1713)  and  Pilarini  (1715),  was  taken 
up  by  Lady  Mary  Wortley  Montagu  in  England  (1721)  and  by  Zabdiel  Boylston 

* J.  J.  von  Plenk,  “Doctrina  de  cognoscendis  et  curandis  morbis  infantorum, ” 
ienna  (1807). 

t C.  Girtanner,  “Abhandlung  fiber  die  Krankheiten  der  Kinder.”  Berlin 
794). 


80 


HISTORY  OF  PEDIATRICS 


in  Boston  (1721),  and  after  a period  of  stagnation  (1727-43),  was  revived  by  the 
success  of  Kirkpatrick  in  South  Carolina  (1743),  Robert  and  Daniel  Sutton  (1760) 
and  William  Watson  (1768)  and  Angelo  Gatti  (1769)  in  Paris,  and  actually  attained 
the  status  of  scientific  preventive  inoculation  during  1764—98.  Variolation  is 
preventive  inoculation  against  smallpox  by  means  of  virus  taken  from  the  human 
subject.  In  folk-medicine,  the  end  was  attained  by  the  East-European  custom  of 
“buying  the  smallpox,’’  i.e.,  by  bringing  coins  moistened  with  virus  from  the  scabs, 
purchased  in  open  market,  into  contact  with  skin.  The  usual  procedure  in  the 
middle  of  the  century  was  inoculation  by  puncture  or  incision,  preceded  by  blood- 
letting and  purging.  Sutton  substituted  a sensible  strengthening  regime  for  this 
depletion  of  the  patient,  and  Kirkpatrick  attenuated  the  virus  by  passing  it  through 
several  human  subjects,  diluting  with  water,  etc.  Gatti  showed  that  apparent 
reinfection  was  due  to  mixed  infection  of  other  .exanthems  (scarlatina,  measles). 
In  this  period  of  experiment  in  preventive  inoculation  prior  to  Jenner,  children 
played  a prominent  part.  Timoni  inoculated  his  daughter  (1707),  Lady  Montagu 
her  infants  (1718-21),  Boylston  his  son  (1721),  Dimsdale  made  a fortune  by 
inoculating  Catherine  of  Russia  and  her  son  (1768),  and  Ingen-Housz  inoculated 
three  of  the  royal  family  of  Austria  (1768),  after  preliminary  experiments  upon 
200  children  of  the  Viennese  suburbs.  Jenner  made  his  first  experiment  in  vaccina- 
tion upon  a country  boy,  James  Phipps,  on  May  14,  1796.  The  great  danger  of 
variolation  was  that  the  inoculated  person  became,  through  the  scab,  a true 
smallpox  carrier,  and  the  inoculation  was  sometimes  fatal.  Vaccination,  with  little 
mortality  and  no  possibility  of  convection,  carried  the  day,  and  variolation  was 
declared  a felony  by  Act  of  Parliament  in  1740.* 

Of  the  many  infantile  diseases  which  were  first  described  and  individualized  by 
the  clinicians  of  the  eighteenth  century,  diphtheritic  croup,  variously  known  as 
angina  puerorum,  angina  polyposa,  angina  maligna,  angina  suffocativa,  angina 
membranacea,  syncope  angionosa,  cynanche  trachealis  and  cynanche  stridula, 
became  better  understood  through  the  careful  accounts  of  John  Fothergill  (1748), 
J.  B.  L.  Chomel  (1749),  John  Huxham  (1757),  Francis  Home  (1765),  and  Samuel 
Bard  (1771).  In  1736,  John  Freke  described  myositis  ossificans  progressiva  in  a 
boy.  Francis  Home  (1719-1813)  made  his  experimental  inoculations  of  measles 
in  1759.  John  Millar  (1733-1805),  in  his  “ Observations  on  the  h!sthma  and  on  the 
Hooping  Cough,”  described  thymic  asthma  (1769).  J.  Z.  Platner  reviewed  the 
Hippocratic  doctrine  of  the  tuberculous  nature  of  gibbous  spine,  with  an  inter- 
esting plate  (1744).  Pellagra  was  described  by  Gaspar  Casal  (1735—62)  and 
Francis  Thierry  (1755)  and  named  by  Francesco  Rappoli  (1771).  Robert  Hamil- 
ton emphasized  the  orchitic  lesion  in  mumps  (1761).  Mestivier  operated  for 
appendicitis,  and  described  the  true  lesion,  from  a pin  (1759).  Heberden  described 
varicella  (1767),  Whytt  tuberculous  meningitis  (1768),  John  Rutty  relapsing 
fever  (1770),  Percival  Pott  and  J.  P.  David  pressure  paralysis  from  spinal  caries 
(1779).  Sir  George  Baker  lead-poisoning  in  children  (1784),  Hezekiah  Beardsley 
congenital  pyloric  stenosis  (1788),  Malacarne  (1788)  and  Fodere  goitre  and 
cretinism  and  Soemmerring  achondroplasia,  with  a fine  plate  (1791V  John 
Machin  (1753),  Henry  Baker  (1753)  and  Tilesius  (1802)  traced  ichthyosis  hvstrix 
through  successive  generations  of  the  Lambert  family. 

American  pediatrics  in  the  18th  century  was  more  remarkable  for 
original  descriptions  of  diseases  than  for  definite  contributions  to  the 
subject. 

The  graduating  thesis  of  the  celebrated  Charles  Caldwell  (1 772-1S52  at  the 
University  of  Pennsylvania  (1796),  attempts  to  show  that  internal  hydrocephalus, 
diphtheria  (cynanche  trachealis)  and  infantile  diarrhea  were  only  symptomatic  of 
fever  in  infants  (S.  S.  Adams). t The  best  individual  contribution  is  the  section 

' * A.  C.  Klebs,  “Die  Variolation  im  achtzehnten  Jahrhundert.”  Giessen 
(1914). 

t S.  S.  Adams,  The  Evolution  of  Pediatric  Literature  in  the  United  States, 
Tr.  Am.  Pediat.  Soc.  N.Y.,  IX,  (1897).,  5-31. 


THE  EIGHTEENTH  CENTURY 


81 


on  diseases  of  children  in  Lionel  Chalmers’  “Account  of  the  Weather  and  Diseases 
of  South  Carolina  '-'  (1776),  which  treats  of  worms,  convulsions,  thrush,  otorrhea, 
catarrhal  peri-pneumonia,  nervous  asthma,  quinsies,  angina,  and  whooping  cough 
(Jacobi).  The  most  remarkable  things  were  the  long  series  of  American  tracts  on 
smallpox,  inoculation  and  vaccination  (1721-1802),  the  accounts  of  diphtheritic 
and  other  anginas  by  William  Douglas  (1736),  Cadwallader  Colden  (1757), 
Samuel  Bard  (1771),  Jabez  Fitch  (1736),  I.  Dickinson  (1740),  Peter  Middleton 
(1780),  Richard  Bayley  (1781),  of  malignant  pleurisy  by  John  Bard  (1749),  of 
yellow  fever  by  John  Bard,  Colden  (1743),  Mitchell  (1741),  William  Currie  (1792), 
Benjamin  Rush  (1796)  John  Lining  (1799),  and  of  congenital  hypertrophic  stenosis 
by  Hezekiah  Beardsley  (1788).  Samuel  Bard’s  account  of  diphtheria  was  trans- 
lated by  Bretonneau  in  his  great  work  of  1826,  highly  praised  by  Jacobi  for  its 
descriptions  of  the  pharyngeal,  tracheo-laryngeal,  and  cutaneous  manifestations, 
and  pronounced  “An  American  classic  of  the  first  rank”  by  Sir  William  Osier,  who 
also  reprinted  Beardsley’s  paper  on  congenital  pyloric  stenosis  in  1903.  Benjamin 
Rush  (1745—1813),  the  greatest  American  clinician  of  his  time,  described  cholera 
infantum  (1773),  dengue  (1780),  influenza  in  children  (1789-91),  and  the  thermal 
fever  occasioned  by  the  drinking  of  cold  water. 

Jacobi,  in  his  “History  of  American  Pediatrics  before  1S00,”*  says  that  measles 
appeared  in  New  England  in  1713,  with  many  later  outbreaks;  epidemics  of 
influenza  from  1647  to  1789  were  described  in  old  records;  scarlatina  broke  out  in 
Philadelphia  and  Salem,  Mass.,  in  September,  1783,  through  New  England  in 
1784,  these  epidemics  lasting  five  years,  and  again  in  Philadelphia  (1789-91)  and 
the  Northern  States  (1792-3).  Diphtheria,  first  reported  in  New  England  in 
1659,  appeared  at  Kingston,  N.  H.,  in  1735-6,  as  the  angina  ulcusculosa”  of 
William  Douglas. 

The  rate  of  infant  mortality  was  dreadfully  high  in  the  18th  century. 

Hand-feeding  had  come  into  fashion,  and  Sir  Hans  Sloane  stated  that  the 
mortality  of  dry-nursed  infants  was  nearly  three  times  that  of  the  breast  fed.  When 
patients  at  the  British  Lying-in  Hospital  were  required  to  suckle  their  own  infants, 
the  mortality  fell  to  60  per  cent.  “Death  from  want  of  breast  milk”  was  the 
common  entry  in  hospital  records. 

Of  10,272  infants  admitted  to  the  Dublin  Foundling  Hospital  during  21  years 
(1775-96),  only  45  survived,  a mortality  of  99.6  per  cent.  Of  31,951  infants 
admitted  to  the  Paris  Foundling  Asylum  during  1771-77,  25,476  (80  per  cent.) 
died  before  the  end  of  their  first  year  (Forsyth).  From  tables  constructed  from 
the  London  Bills  of  Mortality  covering  the  100  years  ending  1829,  the  death  rate 
per  100  of  children  under  5 was:  1730-49  (74.5);  1750-69  (63);  1770-89  (51.5); 
1790-1809  (41.3);  1810  -29  (31. S)  (Edmonds).  | Malthus  said  that  to  multiply 
infant  hospitals  and  foundling  asylums  was  the  surest  means  of  checking  the 
growth  of  the  population.  Id  on  fait  mourir  les  enfans  was  the  inscription  pro- 
posed by  a French  critic  for  the  Parisian  institutions  of  this  kind.  Outside  the 
hospitals,  the  evils  of  babv-farming  and  of  mercenary  wet-nursing  (in  France) 
were  prominent  factors.  The  English  wet-nurses  of  the  period  got  25  guineas  a 
year,  which  led  many  young  women  to  have  illegitimate  children,  who  were 
abandoned  at  foundling  hospitals  or  died  through  babv-farming.  In  France,  the 
evil  was  the  same. 

In  Georgian  England,  mixed  feeding  in  the  shape  of  water-pap  (moistened 
bread),  baked  flour  pap,  weak-broth,  beef-tea,  bread  panada  sweetened  with 
Lisbon  sugar,  French  bread,  Uxbridge  rolls,  and  even  the  minced  meat  of  turtle- 
doves, larks,  thrushes,  ortolans  and  chickens,  was  preferred  to  cow’s  or  goat’s 
milk.  Of  these  infant  foods,  William  Cadogan  observes  in  his  Essay  on  Nursing 
(1750)  that  “their  paps,  panadas,  gruels,  etc.,  are  generally  enriched  with  sugar 
spice  or  a drop  of  wine;  neither  of  which  they  ought  ever  to  taste,”  and  he  adds 

* A.  Jacobi,  Collectanea  Jacobi,  New  York,  iii  (1909),  pp.  1—40. 

t J.  R.  Edmonds,  Lancet,  London,  i (1835-6),  pp.  690-694.  Cited  by  A.  K. 
Chalmers. 

Vol.  1—6 


82 


HISTORY  OF  PEDIATRICS 


that  “The  London  bakers  are  suspected  of  putting  alum  into  their  bread,  which 
would  be  very  pernicious  to  infants;  therefore  rusks,  or  the  biscuits  called  tops- 
and-bottoms,  or  rice  may  be  used  instead  of  it.”  Small  beer  was  given  to  children, 
and  even  Underwood  recommended  a little  red  wine,  as  preventing  rickets  in 
infants  learning  to  walk.  Struve  recommended  three  beaten  yolks  of  eggs  in  a 
sweetened  quart  of  beer  for  infants  after  weaning.*  Of  suckling  apparatus,  the 
cowhorn  (known  on  the  continent  from  the  13th  century)  became  common 
in  England  about  1783  and  was  praised  by  Heberden.  The  glass  nursing  bottle, 
the  pap-boat  and  pap-spoon  did  not  come  into  vogue  until  the  19th  century. 
On  the  continent,  as  we  have  seen,  all  these  methods  had  long  been  known.  Porce- 
lain flasks  are  mentioned  by  Raulin  (1769).  Retort-shaped  glass  flasks  were  intro- 
duced by  Baldwin  (1781).  Raulin  and  Rau  also  recommended  boat-shaped 
cups  and  flat  glasses  with  beaks,  shaped  like  a Roman  lamp.  The  boat  was  first 
mentioned  in  England  by  Armstrong  (1792)  and  held  3-4  fluid  ounces.  Although 
ridiculed  by  Girtanner,  who  inquired  whether  the  “boat”  was  a shallop  or  a war- 
ship, this  form  survived  as  the  “Vienna  ship”  of  Rau,  and  was  used  even  when 
Ammon,  in  1882,  condemned  it  as  making  the  child  swallow  rather  than  suck. 
The  “Cadogan  cans”  were  used  in  England,  but  boats  and  cans  proved  dangerous 
when  made  of  tin.  Cone-shaped  glass  flasks,  provided  with  a nipple,  were  used  up 
to  1875.  Peter  Camper  mentions  a tube  reaching  to  the  bottom  of  the  bottle 
<1777),  a precursor  of  the  modern  sucking  tube  (Bruning).f 

In  1761,  Jean-Jacques  Rousseau  published  Emile,  a tract  on  the 
education  of  children,  which  was  condemned  and  denounced  by  the 
Archbishop  of  Paris  for  its  irreligious  tendencies  (1762).  The  part 
which  immediately  concerns  us  is  the  long  introductory  passage  in 
Book  I,  which  deals  with  the  hygiene,  and  nutrition  of  infancy.  In 
this  passage,  which  is  virtually  a popular  treatise  on  pediatrics,  the 
dangers  of  mercenary  wet-nursing  and  swaddling  infants  are  set  forth, 
women  are  exhorted  to  nurse  their  own  children,  and  along  with  much 
that  is  silly  and  inept,  there  is  much  that  is  sound  and  sensible.  The 
book  is  a tedious  one  to  read,  on  account  of  its  multifarious  rhetorical 
declamation  and  the  foolish,  false  sentiment  of  the  period.  Rousseau, 
himself,  is  said  to  have  consigned  his  five  illegitimate  children  to  a 
foundling  asylum.  He  was  a striker  of  attitudes,  his  life,  as  Carlyle 
said,  “a  long  soliloquy.”  Medicine,  in  particular,  he  ridicules  as  a 
useless  fashionable  cult,  ‘‘the  amusement  of  the  idle,  aimless  people.” 
But  his  revolutionary  ideas  about  “return  to  nature”  appealed  to  the 
people  of  his  time,  and  the  centric  theme  of  his  argument — “ point  de 
mere,  point  d’ enfant  did  much  to  awaken  French  mothers  to  the  obliga- 
tion of  breast-nursing  and  caring  for  their  own  offspring. 

Emile  engendered  a large  crop  of  literature  on  the  dangers  of  mercenary  wet- 
nursing  and  swaddling,  such  as  the  Avis  aux  mbres  of  Madame  Le.Rebours  (1767), 
the  Dcmgers  du  maillot  of  Lascazes  de  Compayre  (1778),  the  Observations  sur 
l’ allaitement  des  enfants  of  Levret  (1781)  and  the  pamphleteering  of  F.  A.  Weiz 
(1782)  and  K.  Strack  (1782-9)  on  the  trade-tricks  of  wet-nurses.  The  Nomothe- 
lasmus  of  Geronomino  Mercuriali  was  fished  up  and  printed  at  Padua  in  17S8. 
Rousseau’s  propagandism  against  wet-nurses  which  had  even  been  preceded  by 
Linnaeus  ( Nutrix  noverca,  1762),  and  others,  found  its  echoes  at  Vienna  in  the 
letters  of  Maximilian  Stoll  (edited  by  Eyerel,  1788),  in  the  pamphlets  of  Cadogan 

* D.  Forsyth,  Proc.  Rov.  Soc.  Med.,  London,  iv  (1910-11),  Sect.  Dis.  Child., 

pp.  121-126. ' 

t H.  Brtining,  “Geschichte  der  Methodik  der  kiinstlichen  Sauglingsernah- 
rung.”  Stuttgart  (1908),  pp.  93-103. 


THE  EIGHTEENTH  CENTURY 


83 


(1750)  and  Benjamin  Lara  (1794)  and  in  Wilmington  in  “The  Female  Monitor” 
of  H.  Smith  (1801). 

While  children  were  cleverly  and  effectively  portrayed  by  Reynolds,  Gains- 
borough, Raeburn  and  other  painters  of  the  period,  the  only  picture  of  special 
pediatric  interest  is  the  copperplate  from  Hogarth’s  “Manage  a la  Mode”  (Plate 
III),  representing  a dissolute  parent  bringing  his  syphilitic  child  to  a quack.  That 
the  primitive  preference  for  male  offspring  was  still  ascendant  is  evidenced  in  the 
engraving  of  J.  J.  Moreau  the  younger,  entitled  “C’est  un  fils,  Monsieur!”  The 


Fig.  9. — J.  M.  Moreau  le  jeune:  “C’est  un  fils.  Monsieur!”  (Preference  for 
male  offspring  in  the  18th  century.) 

glorification  of  the  male  was,  in  fact,  to  reach  its  apogee  in  the  biological  writings 
of  the  Bavarian  naturalist  Lorenz  Oken  (1779-1851),  who  declared  that  “Ideally, 
every  child  should  be  a boy.”  Lecky,  in  his  histories  of  England  and  Ireland  in 
the  eighteenth  century  records  that  infanticide  was  common  in  Scotland  and 
very  rare  among  the  Irish  in  this  period.  Of  cruelty  to  children,  an  outstanding 
instance  may  be  recalled  in  the  childhood  of  Frederick  the  Great  and  his  sister, 
the  Margravine  of  Bayreuth.  Had  the  father  of  these  children  been  less  of  a 
brute,  the  present  European  war  might  never  have  occurred. 

In  the  eighteenth  century  blind  beggars  were  objects  of  ridicule.  They  were 
tricked  out  with  asses’  ears,  peacocks’  tails,  ancLpasteboard  spectacles  to  be  utilized 
in  burlesque  concerts  for  popular  amusement  in  public  places.  Diderot  was  thrown 
into  the  Bastille  for  suggesting  that  they  might  learn  to  read  and  write  by  the  sense 
of  touch.  Rousseau  suggested  a system  of  embossed  printing  for  the  blind,  and 
Valentin  Hauy  (1745-1822)  founded  an  Institute  Nationale  for  young  blind  persons 
in  1785,  which  was  successful.  The  Lettres  sur  les  aveugles  of  Diderot  (1749)  and 
the  Essai  of  Hauy  (1786)  are  the  early  landmarks  of  this  movement.  The  pioneer 


84 


HISTORY  OF  PEDIATRICS 


of  deaf-mute  instruction  in  France  was  the  Abbe  Charles-Michel  de  l’Epee  (1712— 
89)  who  founded  the  first  school  for  deaf-mutes  in  Paris  (1775),  published  a method 
of  instruction  (1784),  and  left  an  unfinished  dictionary  of  the  deaf  and  dumb  signs, 
which  is  said  to  have  been  completed  by  his  successor,  the  Abbe  Cucurron  Sicard. 
In  America,  the  earliest  pioneer  of  the  deaf-mute  instruction  was  Francis  Green 
(1742-1809),  of  Boston,  in  his  Vox  oculis  subjecta  (London,  1783). 


THE  NINETEENTH  CENTURY 

In  reviewing  the  late  pediatric  literature  of  the  nineteenth  and 
twentieth  centuries,  no  attempt  will  be  made  to  analyze  or  criticize  the 
basic  texts.  To  furnish  a critical  inventory  of  the  contents  of  the  older 
writings  is  conceivably  and  admittedly  a function  of  bibliography.  To 
render  a detailed  account  of  the  vast  pediatric  literature  of  recent 
times  is  a fitting  task  for  some  future  specialist  in  children’s  diseases. 
The  outstanding  text-books  before  the  time  of  Heubner  and  Finkelstein 
were  those  of  Billard,  Rilliet  and  Barthez,  Bouchut,  Charles  West, 
Bednar,  Henoch,  Gerhardt  and  Rotch,  with  the  larger  systems  of 
Gerhardt,  Keating,  Starr,  Pfaundler  and  Schlossmann,  Grancher  and 
Comby,  Briining  and  Schwalbe.  In  England,  Underwood  held  the 
field  up  to  the  time  of  Charles  West.  The  names  of  Bednar  and 
Henoch  mark  the  rise  and  predominance  of  modern  German  influences. 
American  pediatrists,  before  the  advent  of  the  metabolists,  have 
pursued  an  independent  course.  The  most  favored  treatises  have  been 
those  of  J.  Lewis  Smith,  Jacobi,  Rotch,  and  Holt.  In  this  period, 
infantile  surgery  and  orthopedics  became  distinct  specialties;  the 
movement  for  the  hygienic  inspection  of  schools  and  school  children 
was  inaugurated  by  Virchow,  Chadwick,  and  Hermann  Cohn;  juvenile 
anthropometry,  ethnology,  psychology,  and  criminology  began  to  be 
studied;  and  the  interest  in  infantile  mortality  as  a phase  of  national 
depopulation  was  the  starting  point  of  the  new  social  science  of  infant 
welfare.  The  spirit  of  the  eighteenth  century  still  informs  the  pediatric 
literature  before  the  time  of  Billard,  particularly  in  the  remarkable 
books  of  Cheyne,  Heberden,  and  John  Clark. 

John  Cheyne  (1777-1836),  of  Leith,  Scotland,  a medical  graduate  of  Edin- 
burgh (1795),  entered  the  army  as  a surgeon  of  artillery.  He  led  a frivolous, 
dissipated  fife  until  he  settled  down  to  solid  practice  at  Leith  Fort  in  1799,  devoting 
himself  to  infantile  and  contagious  diseases.  In  1809,  he  settled  in  Dublin, 
became  physician  to  Meath  Hospital  (1811)  and  physician  general  to  the  forces  in 
Ireland  (1820),  which  was  then  esteemed  the  highest  medical  honor  in  that  country. 
In  1802-8,  he  published  his  Essays  on  the  Diseases  of  Children,  dedicated  to 
John  Rollo,  and  in  1809  his  classic  on  “The  Pathology  of  the  Membranes  of  the 
Larynx  and  Bronchia,”  beautifully  illustrated  with  colored  plates  by  Charles 
Bell.  In  1821,  he  described  the  Dublin  fever  epidemic  of  1817-19.  During 
1810-11,  he  made  only  three  guineas  in  practice,  but  at  the  height  of  his  career  he 
commanded  £5000  yearly.  His  health  failing  in  1825,  he  retired  to  his  estate  at 
Sherington,  Buckinghamshire,  and  died  on  January  31,  1836,  leaving  a posthumous 
essay  on  insanity  (1843),  prefaced  by  an  autobiography.  Cheyne’s  pediatric 
essays  comprise  three  studies  of  cynanche  trachealis  (croup),  the  bowel  complaints 
of  children,  and  acute  hydrocephalus.  These  are  scholarly  performances,  replete 
with  historical  details  and  original  clinical  histories  with  postmortem  findings. 
The  essay  on  bowel  complaints  is  devoted  to  biliary  disorders,  in  particular,  infan- 


THE  NINETEENTH  CENTURY 


85 


tile  jaundice  and  the  “green  scour  (green  stools  with  griping  convulsions)  and  the 
disease  called  weaning  brash  in  Scotland,  or  atrophia  ablactorum  (green  stools 
with  cachexia).  The  essay  on  hydrocephalus  acutus,  dedicated  to  Charles  Bell, 
is  a continuation  of  the  monograph  of 
Whytt,  and  sharply  criticizes  the  views 
of  Benjamin  Rush.  Case  histories  and 
autopsies  are  carefully  recorded. 

In  1803-12,  Karl  Bernhard  Fleisch 
(1778-1814),  of  Cassel,  published  a four- 
volume  Handbook  of  Children’s  Diseases 
containing  a series  of  excellent  bibliog- 
raphies, which  undoubtedly  constitute 
the  germ  of  Meissner’s  chronological 
lists  of  1850.  Fleisch  is  said  to  have 
anticipated  Czerny  in  prescribing  long 
pauses  between  the  suckling  periods  of 
the  nursing  infant.* 

William  Heberden  (1767-1845),  of 
London,  son  of  the  greatest  English 
clinician  between  Sydenham  and  Bright, 
was  an  Oxford  graduate  of  1795, 
physician  to  St.  George’s  Hospital 
(1793-1803),  and  physician  to  the  King 
and  Queen.  He  attended  George  III  in 
his  last  illness.  The  younger  Heberden 
inherited  his  father’s  classical  tastes,  and 
made  translations  of  Cicero’s  Letters 
and  Plutarch  on  Brotherly  Love.  In  1804,  he  published  a Latin  Epitome  of 
pediatrics,!  which  he  himself  translated  into  English  (1805).  Heberden’s  Epitome, 
the  work  of  one  of  the  ablest  Greek  and  Hebrew  scholars  of  his  time,  is  of  all 
pediatric  treatises  the  most  remarkable  for  classic  purity  and  simplicity  of  style. 
In  a tiny  volume,  the  size  of  a child’s  primer,  the  hygiene  and  therapy  of  infancy 
and  some  52  infantile  disorders  are  set  forth  in  61  brief  chapters,  which  have  all 
the  terse  quality  of  the  Hippocratic  aphorisms.  The  very  titles — “still-born,” 
“wind  on  the  stomach,”  “locked  jaw,”  “watery  head,”  “sore  ears,”  “scald 
head” — suggest  the  clinician’s  preference  for  the  plain  English  of  every  day 
practice.  Each  chapter  goes  straight  to  the  point,  with  nothing  of  the  circumlocu- 
tion of  Harris  or  Underwood.  This  unpretentious  booklet  forms  a stable  bridge 
between  the  pediatrics  of  yesterday  and  of  classical  antiquity. 

Adolph  Henke  (1775-1843),  a famous  medical  jurisconsult  of  Erlangen, 
published  a Handbook  of  Pediatrics  (1809),  which  reached  its  fourth  edition  in 
1837,  a Pocketbook  for  Mothers  (1810),  and  monographs  on  developmental  dis- 
eases (18141,  internal  inflammation  in  infants  (1817)  and  pulmonary  docimasia 
(1821). 

John  Clarke  (1761-1815),  of  Wellingborough,  Northamptonshire,  lecturer  on 
midwifery  at  William  Hunter’s  school  in  Windmill  Street  and  at  St.  Bartholomew’s 
Hospital,  was  the  leading  obstetrician  of  London  after  Hunter’s  day,  but  later 
devoted  himself  to  a West  End  practice  in  gynecology  and  pediatrics.  He  pub- 
lished two  volumes  of  obstetric  essays  (1788-93),  and  in  1815,  his  “Commentaries 
on  some  of  the  most  important  Diseases  of  Children”  (Part  I).  The  diseases 
featured  are  disorders  of  dentition,  convulsions,  phrenitis,  idiocy,  paralysis,  and 
epilepsy.  These  Essays  contain  the  first  account  of  laryngismus  stridulus  and  its 
association  with  tetany  (pp.  86-97). 

John  Bunnell  Davis  (1780-1824),  being  forcibly  detained  in  France  by  Napo- 

* Langstein  and  Meyer,  “Sauglingsernahrung  und  Stoffwechsel.”  Wiesbaden 
(1910),  p.  54,  footnote. 

f Heberden,  “Morborum  puerilium  epitome.”  London  (1804).  “Epitome  of 
Infantile  Diseases.”  London  (1805). 


Fig.  10. — John  Cheyne  (1777-1836). 


86 


HISTORY  OF  PEDIATRICS 


leon,  took  his  M.D.  at  Montpellier  (1803),  after  which  he  was  released  through 
Corvisart’s  generosity.  Returning  to  England,  he  took  another  M.D.  at  Edin- 
burgh (1808),  and  after  serving  as  an  army  surgeon  at  Ipswich,  settled  in  practice 
at  London  (1816),  where  he  helped  to  found,  on  St.  Andrew’s  Hill,  the  Universal 
Dispensary  for  Sick  and  Indigent  Children  (1816),  the  first  institution  of  its  kind. 
Davis’s  Annals  of  this  Dispensary  (1821),  during  the  four  years  of  its  activity, 
is  perhaps  the  first  report  of  a children’s  hospital.  He  published  a Cursor  Inquiry 
into  the  principal  causes  of  mortality  in  children  (1817),  in  which  he  was  the  first 
to  advocate  visitations  of  trained  nurses  for  instructing  ignorant  and  indigent 
mothers  in  the  art  of  infant  nutrition  and  hygiene. 

A great  step  forward  was  taken  when  Pierre  Bretonneau  (1771-1862),  the  emi- 
nent clinician  of  Tours,  published  his  monographs  on  the  contagious  nature  of 
typhoid  fever  (1819-29)  and  diphtheria  (1826).  Bretonneau  described  and 
understood  the  lesions  in  Peyer’s  patches  (1820),  predicted  that  typhoid  fever 
would  some  day  be  distinguished  from  typhus  (1821),  and  clearly  stated  the 
doctrine  of  specificity  in  disease  (1826-55).  He  was  a kind  of  specialist  in  diph- 
theria. In  his  monograph  of  1826,* * * §  he  synthetizes  all  the  diseases  described  by  so 
many  various  names  under  one  generic  term  “ diphtherite,"  which  he  introduced, 
elucidates  its  pathology,  describes  the  cutaneous  and  vulvar  forms  and  concludes 
with  historical  extracts  from  Ghisi  (1740),  Samuel  Bard  (1771)  and  the  older 
writers.  This  book  contains  the  first  successful  case  of  tracheotomy  in  diphtheria, 
which  Bretonneau  performed  on  the  child  Elizabeth  de  Puysdgur,  on  July  1, 
1885,  f after  five  successive  failures. 

Johann  Christian  Gottfred  Joerg  (1779-1856;,  a Leipzig  M.D.  of  1805  and  a 
pupil  of  the  obstetrician  Boer,  wrote  much  on  gynecology  and  obstetrics,  early 
orthopedic  treatises  (1810-12),  a handbook  of  pediatrics  (1826)  and  a monograph 
on  pulmonary  diseases  from  imperfect  respiration  in  the  newborn  (1832). 

Joerg’s  pupil,  Friedrich  Ludwig  Meissner  (1796-1857),  who  graduated  in 
medicine  at  Leipzig  (1819),  erected  an  obstetrical  polyclinic  there  in  1838  and  made 
a great  reputation  in  obstetrics  and  gynecology.  He  published  a work  on  super- 
foetation  (1819)  a two-volume  treatise  on  pediatrics  (1828,  3d  ed.  1845)  and  six 
volumes  of  “Forschungen”  (1826-33),  three  of  which  are  devoted  to  a review  of 
pediatric  literature  from  1801  to  1832.  This  led  to  his  invaluable  Grundlage  or 
bibliography  of  pediatrics  (1850), J which  consists  of  a strictly  chronological 
arrangement  of  books  and  monographs  by  subjects,  under  90  subdivisions,  in 
other  words,  a miniature  Index  Catalogue  of  pediatric  literature  from  1472 
to  1849. 

In  1828,  Frederick  Corbyn,  a surgeon  in  the  Bengal  Army,  and  editor  of  the 
Indian  Journal  of  Medical  Science  (1835-42),  published  his  valuable  work  on  the 
management  and  treatment  of  infantile  diseases  in  India,  illustrated  by  inter- 
esting tinted  plates.  The  subject  was  admirably  summarized  in  a little  book  of 
pocket  size,  the  “Hints”  (1844)  of  Henry  Hurry  Goodeve  (1807-84),  another 
Bengal  Army  surgeon,  which  has  been  a vade-mecum  in  Indian  pediatrics  ever 
since,  reaching  its  eighth  Calcutta  edition  in  1886.  Another  treatise  on  tropical 
pediatrics  was  that  of  the  anthropologist  F.  A.  C.  Waitz  (1798-  ),  of  Samarang, 

Java,  published  simultaneously  in  Dutch  and  English  (1843,  2d  ed.,  1866).  This 
was  followed  by  the  treatises  of  S.  C.  Amesburg  (1886),  G.  Montagu  Harston 
(1912),  and  others. 

In  1833-37,  the  Austrian  Army  surgeon  Franz  Josef  Mezler  von  Andelberg 
(1787-1858)  published  a valuable  collection  of  pediatric  essays, § selected  from  the 
best  writers,  such  as  Bischoff  on  the  examination  of  the  sick  child,  Fenner  on 
pediatric  etiquette,  Billard  on  the  semeiology  of  the  infant’s  cry,  Huf eland  on 

* Bretonneau,  “ Des  inflammations  speciales  du  tissu  muqueux  et  en  particulier 
de  la  diphtherite.”  Paris  (1826). 

t Bretonneau,  op.  cit.,  pp.  300-325. 

} F.  L.  Meissner,  “Grundlage  der  Literatur  der  Padiatrik.”  Leipzig  (1850). 

§ Mezler,  “Sammlung  anserleserner  Abhandlungen  fiber  Kinderkrankheiten.” 
Prague  (1833-7). 


THE  NINETEENTH  CENTURY 


87 


general  principles,  fetal  diseases  and  cephalhematoma,  Guibert  on  pericarditis, 
and  Basedow  on  psorophthalmia. 

The  most  important  pediatric  treatise  of  this  early  period  was  that 
of  Charles-Michel  Billard  (1800-32)  of  Pelouaille,  France,  who  studied 
medicine  at  the  Ecole  secondaire  of  Angers  (1819-23)  and  came  up 
to  Paris  in  1824,  having  acquired  the  funds  by  a prize  essay  on  the 
gastrointestinal  mucous  membrane  (1825).  He  was  very  poor,  had  to 
eke  out  his  living  by  translations,  journal  articles  and  other  hack-work, 
and  did  not  get  his  medical  degree  until  1828.  In  the  same  year  he 
published  his  treatise  on  the  diseases  of  newborn  infants  and  sucklings,  * 
with  an  atlas,  (1828,  3d  ed.  1837),  which  was  translated  into  German 
by  Meissner  (1829). 

This  work,  the  fruit  of  Billard’s  internship  at  the  Hospice  des  enfants  trouviis 
(1826-28),  where  he  made  many  autopsies,  was  inspired  by  his  reading  of  Mor- 
gagni, and  indeed,  is  eminently  representative  of  the  French  medicine  of  Bichat’s 
and  Laennec’s  day,  in  which  clinical  notations  were  correlated  with  autopsy 
findings.  It  is,  in  fact,  the  first  pediatric  treatise  in  which  a uniform  classification 
of  diseases  is  attempted  from  a definite  standpoint,  viz.,  that  of  the  pathological 
lesion.  The  book  begins  with  a careful  consideration  of  the  attitudes,  coloration 
of  the  skin,  height  and  weight,  semeiology  of  crying,  facial  expression,  and  pulse 
in  the  newborn.  The  diseases  are  classified  under  the  following  categories:  skin 
(including  exanthematous  fevers,  cancer,  leprosy,  anthrax,  etc.),  digestive  appara- 
tus, viscera,  air  passages,  circulation,  cerebro-spinal  system,  locomotive  system, 
generative  organs,  lymphatics,  eye,  infantile  jaundice,  alterations  of  the  blood, 
abnormities  and  congenital  diseases,  with  medico-legal  considerations,  and  87  case 
histories.  This  is  the  first  classification  of  infantile  diseases  of  any  importance, 
for  many  titles  listed  in  the  older  treatises  are  not  diseases  but  symptoms.  To  the 
second  and  third  editions,  Billard’s  graduating  dissertation  on  the  jurisprudence 
of  viability  (1828)  was  added.  The  work  shows  considerable  research  in  foreign 
literature,  its  author  having  learned  German,  English  and  Italian  in  order  to  write 
it.  After  its  publication,  with  a brilliant  Parisian  career  in  prospect,  Billard,  a 
modest  nature,  returned  to  Angers  with  his  wife  and  child,  and  died  of  phthisis 
on  January  31,  1832. 

The  microscopist  Alexandre  Donne  (1801-78),  of  Paris,  who  first  observed  the 
blood  platelets  (1842),  published  an  important  treatise  on  milk  (1837),  with  plates, 
and  two  books  of  advice  ( Conseils ) to  mothers  and  families  on  the  rearing  of  infants 
and  children  (1846,  1864),  all  of  which  were  translated  into  German. 

Francois-Louis-Isidore  Valleix  (1807-55),  of  Toulouse,  began  the  study  of 
medicine  at  Paris  in  1826,  became  interne  at  the  Children’s  Hospital  (1830)  and 
graduated  with  a dissertation  on  slow  asphyxia  in  the  newborn  (1835).  He  later 
served  at  the  Bureau  central  (1835)  and  other  hospitals,  and  died  in  1855  of 
diphtheria,  contracted  while  treating  a sick  child.  During  his  student  days  in 
hospital,  he  gathered  the  materials  for  his  Clinique  des  malades  des  enfants  nouveau- 
nes  (1838),  which  follows  the  tendency  established  by  Andral  ( Clinique  medical, 
1829-33),  carried  to  the  highest  point  of  perfection  by  Trousseau,  and  latterly 
revived  by  Richard  Cabot,  Morse,  and  others,  viz.,  the  exposition  of  the  data  of 
internal  medicine  by  means  of  clinical  case  histories,  rather  than  by  a formal  text- 
book. This  tendency  characterized  the  first  attempt  at  a pediatric  periodical, 
the  Clinique  des  hopitaux  des  enfans,  (1811,  1841),  as  also  V.  Stober’s  Clinique 
from  the  pediatric  section  of  the  Strassburg  Faculty  (1841),  the  Clinique  of  A. 
Becquerel  and  Vanier  (1843^),  the  reports  from  the  children’s  hospitals  at  Frank- 
fort and  Dresden  (1845-6),  and  the  later  clinical  collections  of  Rittershain  and 
others.  Valleix  also  published  a treatise  on  neuralgia  (1841),  in  which  his  name  is 
eponymically  preserved  in  “Valleix’s  points.’ 

* Billard,  “Traite  des  maladies  des  enfans  nouveaux-nes  et  a la  mamelle.” 
Paris  (1828)’. 


88 


HISTORY  OF  PEDIATRICS 


The  three  outstanding  pediatric  text-books  after  the  time  of  Billard 
were  those  of  Rilliet  and  Barthez,  Bouchut,  and  CharJes  West.  Fred- 
eric Rilliet  (1814-61),  of  Geneva,  began  his  medical  studies  in  Parts 
(1833),  and,  with  his  friend  Antoine-Charles-Ernest  Barthez  (1811-91), 
a Paris  graduate  of  1839,  turned  his  attention  to  pediatrics.  He  gradu- 
ated with  a dissertation  on  typhoid  fever  in  children  (1840),  and  later 
returned  to  Geneva,  where  he  described  the  local  epidemics  of  measles 
(1847),  mumps  (1850)  and  cholera  (1856).  Before  graduation,  he  had 
begun,  with  Barthez,  the  famous  Traite  clinique  et  'pratique  de.s  maladies 
des  enfants,  which,  after  seven  years’  wrork,  was  completed  in  three 
volumes  (1838-43),  crowned  by  the  Academy  of  Sciences  and  Academy 
of  Medicine,  authorized  by  the  Council  of  Public  Instruction,  and 
passed  through  three  editions,  the  third  (1884),  being  completed  by 
Barthez  and  A.  Sanne,  a laureate  of  the  Academy  of  Medicine,  who  was 
noted  for  his  treatise  on  diphtheria  (1877)  and  his  graduating  disserta- 
tion on  tracheotomy  in  croup  (1869). 

This  great  work  began  definitely  with  a volume  on  infantile  pneumonia  in  1838. 
The  first  edition  (1843),  follows  the  general  lines  laid  down  by  Billard  and  contains 
many  case  histories.  In  the  second  edition  (1861),  the  case  histories  begin  to 
disappear,  and  the  treatise  is  enriched  by  historical  studies  of  the  different  dis- 
eases and  by  the  valuable  interim  clinical  studies  of  the  authors,  in  particular, 
Rilliet  on  tuberculous  meningitis  (1846),  intestinal  hemorrhage  of  the  newborn 
(1848),  sclerema  (1848),  essential  paralysis  (1851),  poliomyelitis  (1851),*  encephalo- 
pathic  albuminuria  (1853),  dyspepsia  and  apepsia  (1854),  dilatation  of  the  stomach 
(1858)  and  Rilliet  and  Barthez  on  the  history  of  typhoid  fever  and  the  anginas 
(1840-41),  tuberculosis  of  the  bronchial  glands  (1840-41),  chronic  hydrocephalus 
(1842),  arachnoidal  hemorrhage  (1842),  the  history  of  bronchitis  and  broncho- 
pneumonia (1851)  and  the  signs  of  chronic  pleurisy  (1852-3J.  In  the  third  edition 
(1884),  sometimes  called  “Barthez  and  Sanne,”  the  case  histories  have  entirely 
disappeared,  after  the  modern  fashion,  and  the  details  of  historical  development  of 
different  diseases  in  children,  with  the  valuable  footnotes,  make  this  edition,  in  the 
words  of  Ruhrah,  “ a perfect  treasure-house  of  information,”  f a book  for  the  desk  of 
all  learned  pediatrists.  The  account  of  poliomyelitis  occurs  on  p.  545  of  Vol.  II 
of  the  second  edition  (1861).  Much  attention  is  paid  to  gastritis  and  “softening 
of  the  stomach”  described  by  Jaeger  (1786),  which  John  Hunter  regarded  as  post- 
mortem auto-digestion,  which  Trousseau  defined  as  a “choleriform  enteritis”  with 
post-mortem  gastric  changes,  and  which  the  earlier  American  pediatrists  termed 
cholera  infantum  or  “summer  complaint”  (“cholerine”  of  Bourgeois). 

Ernest  Bouchut  (1818-91),  a Paris  graduate  of  1842  and  physician 
to  the  Hopital  des  enfants  malades  (1872),  was  a pioneer  in  the  use  of 
the  ophthalmoscope  in  the  diagnosis  of  nervous  diseases  (1865)  and 
the  jurisprudence  of  death,  wrote  an  important  book  on  neurasthenia 
(Du  nervosisme,  1860)  a good  history  of  medicine  (1864,  1873),  an  atlas 
of  ophthalmoscopy  and  cerebroscopy  (1876),  treatises  on  diagnosis 
(1883),  seminal  vitalism  (1888)  and  several  important  books  on  pedi- 
atrics, notably  those  on  the  diseases  of  children  (1845,  6.  ed.,  1873) 
and  the  hygiene  and  nutrition  of  infants  (1845,  5.  ed.,  1866).  In  1858, 
he  published  important  researches  on  the  laws  of  infantile  mortality, 

* Rilliet,  Gaz.  Med.  de  Paris,  vi  (1851),  3d  s.,  pp.  6S1.  704. 

t J.  Ruhrah,  “A  Manual  of  the  Diseases  of  Infants  and  Children,”  3d  ed., 
Philadelphia  (1911),  p.  514. 


THE  NINETEENTH  CENTURY 


89 


and,  in  1884,  a pediatric  Clinique  which  consists  of  60  clinical  lectures, 
like  those  of  Andral,  Valleix  and  Trousseau.  In  1858,  he  outlined  a 
plan  for  intubation  of  the  larynx,  which  met  with  such  rebuffs  from 
the  Academy  of  Medicine  that  he  abandoned  it. 

His  Manual  pratique  of  1845,  treats  of  the  hygiene  and  nutrition  of 
infancy,  the  semeiology  of  infantile  diseases,  after  the  manner  of 
Billard,  with  sections  on  diseases  of  the  mouth,  abdomen,  nose,  larynx, 
chest,  exanthemata  and  skin  diseases,  eyes  and  rickets,  illustrated  by 
clinical  cases.  The  sixth  edition  (1873)  is  a massive  volume  of  1092 
pages.  Although  Bouchut  was  a famous  medical  historian  in  France, 
his  pediatric  treatise  contains 
little  history,  but  his  book  on 
infant  hygiene  is  illustrated  with 
interesting  pictures  of  nursing 
bottles,  bathing,  walking  chairs, 
jumpers  and  gymnastic  apparatus. 

The  greatest  English  pediatrist 
of  his  time,  and  perhaps  the  most 
genial  practitioner  of  the  art  who 
ever  lived,  was  Charles  West,  of 
London  (1816-98).  The  son  of 
a Baptist  lay  preacher,  West  was 
prevented  by  his  father’s  religious 
prejudices  from  entering  Oxford, 
and  after  a medical  apprenticeship 
with  Mr.  Gray  at  Amersham, 
where  he  became  exceedingly  skil- 
ful in  compounding  medicines,  he 
studied  at  Bonn,  Paris,  and  Berlin, 
where  he  graduated  M.D.  with 

an  illustrated  dissertation  on  the  ^ ^ 

female  pelvis  (1837).  While  wait-  (1818-91).  (Surgeon  General’s 
ing  for  practice  in  London,  he  Library.) 
put  in  a summer  at  the  famous 

Rotunda  Lying-in  Hospital  of  Dublin  and  at  Meath  Hospital  under 
Graves  and  Stokes  (1838).  In  1842,  he  was  appointed  physician  to. 
the  Infirmary  for  Children  in  Waterloo  Road  and,  in  1845,  lecturer  on 
midwifery  at  the  Middlesex  Hospital.  In  the  meantime,  he  had 
written  much  and  had  translated  Naegele  on  Obstetric  Auscultation 
(1839)  and  Johannes  Muller  on  the  structure  of  cancer  and  tumors 
(1840).  In  1847,  he  gave  a course  of  lectures  on  diseases  of  children 
at  Middlesex  Hospital,  the  substance  of  his  great  work.  During 
1848-60,  he  delivered  lectures  on  midwifery  at  St.  Bartholomew’s 
Hospital,  which,  with  his  published  lectures  on  diseases  of  infancy  and 
childhood  (1848)  and  on  diseases  of  women  (1856-8),  were  the 
foundation  of  his  fame.  In  1852,  West  established  the  Children’s 
Hospital  in  Great  Ormond  Street,  where  he  was  senior  physician 


90 


HISTORY  OF  PEDIATRICS 


until  1875.  What  he  did  for  this  institution  will  be  described 
in  the  section  on  Hospitals.  Admitted  to  the  Royal  College  of 
Physicians  in  1842,  he  became  fellow  (1848),  censor  (1863)  and 
senior  censor  (1870)  and  delivered  the  Croonian  lectures  on  ulceration 
of  the  os  uteri  (1852),  the  Lumleian  lectures  on  “Some  Disorders  of  the 
Nervous  System  in  Childhood”  (1871)  and  the  Harveian  oration 
(1874).  About  1878  he  became  a Roman  Catholic.  In  1880,  he 
was  driven  by  bad  health  from  the  London  fogs  to  Nice,  where  he 
practised  until  1885.  He  settled  in  Harley  Street,  where  many  of  his 
old  patients  came  back  to  him,  but  he  found  the  doors  of  the  London 
hospitals  closed  to  him,  and  after  some  years  of  travel  and  struggle  with 
ill  health,  he  died  at  Paris  on  March  19,  1898,  at  the  age  of  81.  West,  a 
refined,  sensitive,  pietistic  nature,  a born  orator,  a master  of  simple  flaw- 
less English,  took  his  profession  with 
priest-like  seriousness,  was  some- 
times in  hot  water  with  colleagues, 
had  to  leave  the  Children’s  Hospital 
and  St.  Bartholomew’s,  but  was  an 
ideal  physician  with  women  and 
children.  Children  stopped  crying 
and  came  to  him  at  once.  Through 
a charming  ritual,  with  marvellous 
toys,  of  which  the  drawers  of  his 
office  desk  were  full,  he  had  no  diffi- 
culty in  making  the  most  accurate 
diagnosis,  wrote  the  most  palatable 
prescriptions  and  never  gave  a medi- 
cine which  he  had  not  previously 
tasted  himself.  In  spite  of  the  pro- 
fessional hazards  incurred  by  his  ideal 
of  the  physician’s  calling — Benedictus 
qui  venit  in  nomine  Domini — he  prac- 
tised his  specialty  in  a big  human 
way,  rarely  equalled  and  never  excelled.* 

The  pediatric  writings  of  West  include,  besides  the  treatises  mentioned,  a 
beautiful  lecture  to  nurses  on  “How  to  nurse  sick  children,”  first  issued  anony- 
mously (1852),  later  under  his  own  name  (1855).  This  is  a good  example  of  the 
classical  perfection  and  simplicity  of  his  style,  as  also  his  “Mother’s  Manual  of 
Children’s  Diseases”  (1885).  The  pediatric  treatise  of  1848,  passed  through  seven 
editions,  and  was  translated  into  nearly  every  European  language,  including 
Arabic.  The  German  translation  of  1865  was  edited  by  Henoch.  The  sixth 
edition  is  based  upon  nearly  200  clinical  cases  and  600  post-mortem  examinations. 
The  book  opens  with  an  admirable  lecture  on  examination  of  the  sick  child,  and 
case-taking,  after  which  diseases  of  the  brain  and  nervous  system,  respiratory 
organs,  heart,  digestive  organs,  urinary  organs  and  fevers  are  handled  in  successive^ 
chapters.  The  classification  is  a capite  ad  calcem,  as  in  the  old  Salernitan  treatises. 
The  importance  of  breast  feeding  in  the  prevention  of  infantile  diarrhea  and  tuber- 
culosis is  emphasized.  The  account  of  infantile  tuberculosis,  the  account  of 
poliomyelitis  (Kennedy’s  or  morning  paralysis),  and  the  table  showing  the  com- 
position of  different  kinds  of  milk  with  the  deduction  that  asses’  milk  is  chemically 

* For  the  life  of  West,  see  Brit.  Med.  Jour.,  i (1908),  pp.  921-923. 


Fig.  12. — Charles  West  (1816-98). 


THE  NINETEENTH  CENTURY 


91 


the  best  for  infant  feeding  are  important  points  in  the  book,  which  Jacobi  describes 
as  “one  of  the  most  instructive  and  eloquent  in  medical  literature.” 

American  pediatric  literature  up  to  1896  has  been  carefully  analyzed 
by  Samuel  S.  Adams.* 

The  outstanding  items  are  the  post-mortem  sections  of  cholera  infantum  by 
James  Stuart  (1806),  James  Jackson  (1812),  William  E.  Horner  (1829)  and  j. 
Lewis  Smith  (1858),  Edward  Miller’s  advocacy  of  cold  bathing  in  fevers  and  cold 
clysters  in  tormina  and  tenesmus  (1814),  the  pioneer  brief  for  school  hygiene  by 
Edward  Reynolds  (1833),  W.  W.  Gerhard’s  papers  on  smallpox  (1832),  measles 
(1833),  tuberculous  meningitis  (1833)  and  pneumonia  (1834)  in  children,  Samuel 
Jackson’s  paper  on  cold  water  in  malignant  scarlatina  (1833),  John  Watson’s 
letter  on  surgical  diseases  of  childhood  (1853),  Joseph  O’Dwyer’s  device  of  intuba- 
tion in  diphtheritic  croup  (1879-86)  and  the  pediatric  treatises  of  “An  American 
Matron”  (1810),  George  Logan  (1825,  William  P.  Dewees  (1825),  which  combats 
swaddling,  the  abuse  of  cradle-rocking  and  the  chewing  of  infant’s  food  by  the 
nurse,  John  Eberle  (1833),  who  follows  Dewees,  James  Stewart  (1843),  D.  Francis 
Condie  (1847),  J.  Forsyth  Meigs  (1848),  Charles  D.  Meigs  (1850),  J.  B.  Beck  on 
infant  therapeutics  (1849)  and  the  later  books  of  Jacobi,  Smith,  Keating,  Starr, 
Rotch  and  Holt. 

It  seems,  in  an  old  cant  phrase  “almost  providential”  that  Meissner 
should  have  extended  his  fine  bibliography  of  pediatrics  up  to  the  year 
1850,  for  his  arrangement  of  titles  affords  a clear  view  of  the  different 
cross-currents  affecting  the  progress  of  this  science  at  the  close  of  an 
epoch.  Helmholtz’s  essay  on  the  Conservation  of  Energy  (1847), 
Virchow’s  Cellular  Pathology  (1858)  and  Darwin’s  Origin  of  Species 
(1859)  signalized  the  advent  of  a new  way  of  looking  at  things,  the 
beginnings  of  the  more  exact  and  scientific  medicine  of  the  laboratory 
and  the  clinic.  While  this  tendency  did  not  affect  pediatrics  appreci- 
ably before  the  beginning  of  the  twentieth  century,  it  was  heralded  by 
the  rise  of  German  influences  in  the  works  of  Bednar,  Gerhardt  and 
Henoch,  the  forerunners  of  the  metabolists.  Up  to  the  middle  of  the 
century,  the  trend  of  pediatrics  had  been  determined  by  French 
influences,  which  were  fourfold,  viz.,  the  effect  of  the  teachings  of 
Bichat,  Cruveilhier,  Laennec,  Louis  and  Chomel  upon  internal  medi- 
cine; second,  the  cult  of  teaching  internal  medicine  and  pediatrics  by 
case  histories,  inaugurated  by  Andral  and  Valleix;  third,  the  example 
set  by  Billard  in  the  classification,  nomenclature,  and  delineation  of 
infantile  diseases;  fourth,  the  effect  of  the  doctrines  of  Broussais,  which 
exerted  a marked  effect  upon  infantile  pathology  for  nearly  half  a 
century.  Broussais  maintained  that  disease  is  merely  the  effect  of 
local  inflammation  upon  some  part  of  the  body,  that  specific  morbid 
poisons  are  non-existent,  that  to  label  a group  of  symptoms  with  a 
name  is  merely  “ontology,”  and  that  most  internal  disorders  are  the 
effect  of  gastro-enteritis.  All  medical  Paris  was  for  a time  polarized 
by  these  theories  of  Broussais,  an  old  army  surgeon  of  Napoleon’s 
campaigns,  who  had  once  sworn  at  troops  as  a sergeant  and  swung 
a privateersman’s  cutlass  in  the  Revolution.  As  he  approached  the 
scriptural  span  of  life,  Broussais  grew  more  and  more  tyrannical. 
Laennec  likened  him  to  Paracelsus.  The  satirical  fun-loving  Parisians 

* S.  S.  Adams,  Tr.  Am.  Pediat.  Soc.,  N.  Y.,  ix  (1897b  PP-  5-31. 


92 


HISTORY  OF  PEDIATRICS 


of  the  younger  set — Louis,  Chomel,  Trousseau,  Velpeau — were  fain  to 
see  him  as  Gambetta  later  envisaged  MacMahon:  “II  est  rente  parce 
qu'il  n’a  pas  compris  qu’il  devait  s’en  alter.”  But  through  his  influence 
infantile  diarrhea,  typhoid,  and  other  intestinal  disorders  were  regarded 
as  symptoms  of  gastro-enteritis.  Even  after  the  time  of  Billard,  indeed 
as  late  as  1845,  P.  Hood  in  his  “Practical  observations  on  the  diseases 
most  fatal  to  children,”  proposes  that  they  be  treated  as  resulting  from 
“irritation”  rather  than  inflammation,  which  is  mere  empty  phrasing. 
The  attempt  at  an  exact  classification  of  the  disorders  of  infant 
nutrition  is  mainly  characteristic  of  Bednar,  Gerhardt,  Henoch,  and 
the  later  German  school. 

Between  1800  and  1850,  Meissner  lists  some  150  separate  treatises  on  pediatrics. 
Apart  from  those  already  named,  the  books  of  Friedrich  Jahn  (1803),  which  follow 
the  Brunonian  theory,  Ludwig  Formey  (1811),  J.  Capuron  (1813),  J.  Feiler  (1814), 
L A Golis  (1815),  J.  M.  Combes-Brassard  ( L’ami  des  meres,  1819),  A.  Levreton 
(1820),  M.  Veron  (1821),  C.  T.  .Haden  (1827),  F.  A.  von  Ammon  (1827),  Miles 
Marley  (1830),  F.  L.  Legendre  (1846),  James  William  Coley  (1846)  deserve 
mention.  From  Dublin  came  the  “ Observations  ” of  Gustave  Hume  (1803)  and 
the  “Practical  Treatise”  of  Richard  T.  Evanson  and  Henry  Maunsell  (1836), 
from  Italy  the  “Compendio”  of  Giuseppe  Maruncelli  (Naples,  1808). 

In  the  second  half  of  the  nineteenth  century,  the  principal  writers 
on  pediatrics  were  mainly  German.*  After  the  death  of  Parrot  French 
pediatry  passed  into  eclipse  and,  in  1904,  Escherich  declared  its  glory 
had  departed  from  it  (Hutinel). 

Alois  Bednar,  a docent  at  the  University  of  Vienna,  was,  in  the 
words  of  Jacobi,  “one  of  the  most  original  scientific  pediatrists  of 
Europe,”  an  active  and  enlightened  teacher  who  never  attained 
to  the  professoriate.  He  was  author  of  a treatise  on  the  diseases  of 
newborn  and  suckling  infants,  in  four  parts  (1850-53),  which  was 
translated  into  Dutch,  a pediatric  Lehrbuch  (1856),  and  a treatise  on 
infant  diet  (1857).  He  gave  the  original  description  of  Bednar’s 
aphthae,  which  had  been  adumbrated  by  Felix  Wiirtz.  His  pediatric 
treatise  is  distinguished  by  most  careful  accounts  of  the  different 
toxemias  of  infancy,  which  were  so  plentiful  in  the  foundling  asylums 
of  his  time. 

Carl  Hennig  (1825-1911),  of  Dresden,  graduated  in  1848,  at  Leipzig, 
where  he  became  director,  of  the  Pediatric  Polyclinic  (1855),  and,  in 
1863,  of  the  Children’s  Hospital  founded  by  him,  and  from  which  he 
issued  reports  (1866-82).  He  published  treatises  on  pediatrics  (1855, 
3d  ed.,  1864),  gynecology  (1S93),  and  obstetrics  (1893),  and  wrote  the 
monographs  on  the  history  of  pediatrics,  cephalhematoma,  umbilical 
diseases,  sclerema,  diseases  of  the  female  sexual  organs,  and  diseases  of 
the  thymus  gland  in  the  Gerhardt  Handbuch  (1877-93).  His  exact 
and  learned  pediatric  treatise  would  have  been  better  recognized  had 
he  attained  more  worldly  prominence  (Jacobi). 

* In  selecting  and  arranging  the  pediatric  writers  of  the  modern  German  school, 
I wish  to  acknowledge  the  valuable  information  kindly  furnished  me  by  the  late 
Dr.  A.  Jacobi,  whose  advice  to  younger  men  was  ever  generous,  encouraging  and 
sympathetic. 


THE  NINETEENTH  CENTURY 


93 


Alfred  Vogel  (1829-90),  of  Munich,  and  Erlangen  graduate  (1853), 
an  assistant  in  Pfeuffer’s  clinic  (1853-55),  and  later  professor  and 
director  of  the  medical  clinic  at  Dorpat  (1866-86),  was  the  author  of 
clinical  investigations  on  typhoid  fever  (1856,  2d  eel.,  1860),  a new  test 
for  milk  (1862),  a monograph  on  diseases  of  the  lips  and  mouth  (1874), 
and  a text-book  of  children’s  diseases  (1860),  which  passed  through 
twelve  editions  and  was  translated  into  English. 

Johann  Heinrich  Rehn,  a graduate  of  Marburg  (1855),  was  one  of 
the  first  to  study  epidemic  jaundice  in  children  (1869),  published  an 
atlas  of  the  bony  alterations  of  the  chest  (1875),  described  nodular 
rheumatism  as  an  affection  peculiar  to  the  tendon-sheaths  (1878),  and 


contributed  the  monographs  on  rickets  (1878)  and  diseases  of  the 
peritoneum  (1879)  to  the  Gerhardt  H andbuch. 

Carl  Gerhardt  (1833-1902),  of. Speyer,  a pupil  of  Bamberger  and 
Griesinger,  graduated  at  Wurtzburg  (1857),  became  professor  and 
leader  of  the  Medical  Clinic  at  Jena  (1861),  and  succeeded  Bamberger 
at  Wurtzburg  (1872)  and  Frerichs  at  Berlin  (1885).  Although  one  of 
the  greatest  pediatrists  of  modern  times,  he  disliked  specialism  and 
eschewed  it.  To  laryngology  he  contributed  his  famous  monographs 
on  laryngeal  croup  (1859),  paralysis  of  the  vocal  cords  (1863-72), 
laryngeal  tumors  (1896),  diseases  of  the  pleura  and  syphilis  of  the 
larynx,  and  trachea  (1898);  to  diagnosis,  his  treatise  on  auscultation 
and  percussion  (1866),  to  pediatrics,  his  Lehrbuch  (1861,  5th  ed., 
1897-9)  and  the  great  Handbuch  of  1877-96,  to  which  the  most  eminent 
German  pediatrists  of  his  time  contributed,  and  which,  with  the  third 
edition  of  Rilliet  and  Barthez  (1884),  is  the  main  storehouse  of  historic 
data  about  children’s  diseases.  He  also  introduced  the  iron  chloride 


Fig.  13.— Carl  Gerhardt  (1833-1902). 


Fig.  14. — Johann  Thoedor  August 
Steffen  (1825-1909).  (Courtesy  of 
Dr.  A.  Jacobi,  New  York.) 


94 


HISTORY  OF  PEDIATRICS 


reaction  for  acetonemic  urine  (1865).  He  was  a master  of  concise 
expression.  “Every  sentence,”  says  Jacobi,  “expressed  a fact,  a 
truth.”  He  died  on  July  21,  1902,  in  the  same  year  with  Virchow, 
Kussmaul,  and  Ziemssen. 

Johann  Theodor  August  Steffen  (1825-1909),  of  Stettin,  a graduate 
of  Halle  (1848),  was  Pfeuffer’s  assistant  at  Heidelberg  (1847-48)  and 
subsequently  physician  in  chief  at  the  Children’s  Hospital  founded  by 

him  at  Stettin  (1853-1900).  From 
this  institution  came  his  Klinik  der 
Kinderkrankheiten  (1865—89),  his 
essays  and  observations  on  certain 
important  children’s  diseases 
(1895),  and  his  monographs  on  the 
pathological  anatomy  of  childhood 
(1901)  and  malignant  tumors  in 
children  (1905).  To  the  Ziemssen 
Handbuch,  he  contributed  the 
articles  on  whooping  cough  and 
spasm  of  the  glottis  (1876),  to  the 
Gerhardt  Handbuch  that  on  cerebral 
disease  in  children  (1879).  He  was 
also  coeditor  of  the  Jahrbuch  fur 
Kinderheilkunde  (1867-1900).  In 
1898,  Steffen  proposed  a strong  diet 
for  infancy,  the  harmful  effects  of 
which  were  denounced  by  both 
Heubner  and  Czerny  (1900).* 
Eduard  Heinrich  Henoch  (1820- 
1910),  of  Berlin,  a pupil  of  Schon- 
lein  and  Romberg  (his  uncle), 
graduated  at  Berlin  in  1842,  became 
professor  extraordinarius  (1858)  and  was  director  of  the  Pediatric 
Clinic  and  Polyclinic  at  the  Charite  for  twenty  years  (1872-93)  after 
which  he  retired  to  Meran  and  Dresden.  He  published  clinical  contri- 
butions from  Romberg’s  polyclinic  (1846-51),  a clinic  of  abdominal 
diseases  (1852-58),  a series  of  Contributions  to  Pediatrics  (1861-68), 
lectures  on  children’s  diseases  (1881,  11th  ed.,  1903),  which  was  trans- 
lated into  English  (Sydenham  Society,  1889),  twice  into  Russian  (1881, 
1888),  and  French  (1885).  He  translated  George  Budd’s  treatise  on 
diseases  of  the  liver  (1846)  and  Charles  West  on  diseases  of  children 
(1872)  and  was  the  first  to  describe  abdominal  purpura  (Henoch’s 
purpura,  1874)  and  dyspeptic  asthma  (1876).  A Festschrift  ( Pcidia - 
trische  Arbeiten),  edited  by  Adolf  Baginsky,  was  published  in  honor  of 
his  seventieth  birthday  in  1890.  His  lectures  on  pediatrics  are 
written  in  classic  style  and  are  described  by  Jacobi  as  “belonging  to 

* Steffen,  Jahrb.  f.  Kinderheilk.,  xlvi  (1S98),  p.  332;  Heubner,  Jacobi  Fest- 
schrift (1900),  p.  290;  Czerny,  Jahrb.  f.  Kinderheilk.,  li  (1900),  p.  15.  Cited  by 
Czerny-Keller. 


Fig.  15. — Eduard  Heinrich  Henoch 
(1820-1910).  (Courtesy  of  Dr. 
George  N.  Acker,  Washington,  D.  C.) 


THE  NINETEENTH  CENTURY 


95 


the  most  exquisite  specimens  of  literature.”  Upon  his  retirement  in 
1893  his  chair  was  offered  to  Jacobi,  but  being  declined,  was  occupied 
by  Heubner  and  subsequently  by  Adalbert  Czernjy 

Otto  Soltmann  (1844—1912)  of  Berlin,  became  professor  extra- 
ordinarius  at  Breslau  (1884),  where  he  was  director  of  the  Wilhelm 
Augusta  Hospital  (1872)  and  the  Children’s  Home  (1882).  Called  to 
Leipzig,  he  became  director  of  the  University  Clinic  (1894)  and  built 
the  large  Children’s  Hospital  there 
(1898).  He  contributed  to  the 
Gerhardt  Handbuch,  published  a 
book  on  the  treatment  of  diseases 
of  nurslings  (1881,  2d  eel.  1886) 
and  wrote  on  infantile  neurology 
(1875-78),  gestures  of  sick  children 
(1887),  pavor  nocturnus  (1888), 
children’s  handwriting  (1890),  phy- 
siological peculiarities  of  childhood 
(1895),  wth  Arbeit eM  from  his  clinic 
(1896-98), 

Philipp  Biedert  (1847-1916), 
graduated  at  Giessen  with  a dis- 
sertation on  the  chemical  differ- 
ences between  human  and  cow’s 
milk  (1869,  2d  ed.,  1884),  served  as 
a volunteer  medical  officer  in  the 
Franco-Prussian  War,  became  head- 
physician  of  the  City  Hospital  at 
Hagenau  (Alsace)  and  professor 
(1895).  He  was  one  of  the  original 
founders  of  the  German  Society  of 
Pediatrics  (1883),  and  inaugurated 
the  science  of  artificial  infant  feeding.  In  1879,  he  described  “fat 
diarrhea”  (Demme,  1874-77).  He  published  a treatise  on  infant 
nutrition  (1880,  5th  ed.,  1905),  edited  the  ninth  and  later  editions  of  the 
Vogel  Lehrbuch,  and  a volume  on  the  care  of  children  called  Das  Kind 
(1906).  Maintaining  that  cow-casein  is  far  less  digestible  than  casein 
of  human  milk,  he  introduced  a series  of  graduated  mixtures  of  cream, 
water  and  milk-sugar  ( Rahmgemenge ) as  surrogates  for  cow’s  milk,  from 
which  came  the  earliest  preparation  of  preserved  cream  (ramogen). 
In  1888,  Biedert  signalized  the  difficulty  of  digesting  casein  as  a promi- 
nent cause  of  infantile  disorders. 

Adolf  Baginsky  (1843-1918),  of  Ratibor,  Silesia,  a pupil  of  Virchow 
and  Traube,  graduated  at  Berlin  (1866),  served  in  the  Franco-Prussian 
War,  opened  a special  polyclinic  for  children’s  diseases  in  Berlin  (1872) 
and  became  professor  extraordinarius  in  the  University  (1891).  In 
1890,  in  collaboration  with  Virchow,  he  founded  the  Kaiser-und 
Kaiserin-Friedrich  Kinderkrankenhaus,  of  which  he  was  director. 
His  pediatric  writings  include  a Handbook  of  School-Hygiene  (1876, 


Fig.  16. — Adolf  Baginsky  (1S43- 
191S).  (Courtesy  of  Dr.  J.  H.  Hess, 
Chicago.) 


96 


HISTORY  OF  PEDIATRICS 


3d  ed.,  1898-1900),  a series  of  “Practical  Contributions  to  Pediatrics” 
(1881-84),  a text-book  of  children’s  diseases  (1882,  7th  ed.,  1902), 
monographs  on  diphtheria  (1893-5),  a treatise  on  infant  hygiene  and 
infant  nutrition  (with  Paul  Scmmerfeld,  1906),  and  a large  number 
of  separate  essays  and  popular  writings.  He  was  one  of  the  most  active 
and  practical  scientific  pediatrists  of  modern  times.  In  1877,  he 
founded,  with  Alois  Monti,  the  Central-Zeitung  fur  Kinderheilkunde 
(1877-9),  which  in  1880  became  the  Archiv  fiir  Kinderheilkunde,  of 
which  he  was  co-editor  up  to  1918,  the  volume  for  1913  being  a Fests- 
chrift in  his  honor.  He  also  edited  a series  of  Arbeiten  from  the 
Friedrich  Children’s  Hospital  (1891-97). 

Of  the  Austro-Hungarian  pediatrists,  Ludwig  Mauthner  von 
Mauthstein  (1806-58),  of  Raab,  graduated  at  Vienna  (1831)  and 
became  an  army  surgeon.  Renouncing  his  military  career  in  1837,  he 
took  up  pediatrics  in  Vienna.  He  founded  an  Institute  for  the 
treatment  of  poor  sick  children,  which  is  the  present  St.  Ann  Hospital. 
Here  Mayr,  Widerhofer  and  Escherich  made  themselves  famous  as 
teachers.  In  1844,  Mauthner  opened  the  first  pediatric  clinic.  In 
1850,  he  acquired  a Children’s  Hospital  and  a professorial  position. 
He  was  ennobled  in  1849.  He  published  reports  from  St.  Ann  (1851), 
treatises  on  diseases  of  the  brain  and  spinal  cord  in  children  (1854)  and 
on  diet  in  children  (1853). 

Johann  Steiner  (1832-76),  a graduate  of  Prague  (1858),  where 
he  became  professor  extraordinarius  (1866),  was  the  author  of  many 
contributions  to  clinical  pediatrics,  and  of  a compendium  (1872),  which 
was  translated  into  English  by  Lawson  Tait  (1874)  and  into  French 
(1880). 

The  founder  of  the  brilliant  Vienna  school,  with  its  elaborated 
semeiotics,  was  Franz  Mayr  (1814-63),  of  Uderns,  Tyrol,  a Vienna 
graduate  of  1845,  who  rose  from  bitter  poverty,  to  be  director  of  St. 
Ann  and  professor  of  pediatrics  in  the  University.  He  made  extended 
clinical  studies  of  594  cases  of  measles  (1852)  and  congenital  syphilis 
(with  Widerhofer  and  others,  1862),  wrote  a manual  on  care  of  children 
(1840)  and  was  first  editor  of  the  Jahrbuch  fur  Kinderheilkunde  (1857- 
63). 

Hermann  Widerhofer  (1832-1901)  graduated  at  Vienna,  where  he 
became  professor  in  1885.  He  wrote  a monograph  on  diseases  of  the 
umbilicus  in  the  newborn  (1863),  the  articles  on  diseases  of  the  bron- 
chial glands,  stomach  and  intestines  in  the  Gerhardt  Handbuch  (1878- 
80)  and  was  co-editor  of  the  Jahrbuch  fur  Kinderheilkunde  (1863-1901). 
From  Widerhofer  and  his  pupils  came  the  close  delineations  of  the 
disorders  of  infantile  nutrition,  which  Heubner  praises.  Widerhofer’s 
classification  of  gastro-intestinal  diseases  is  however,  characterized  by 
an  extraordinary  minuteness. 

Gottfried  Ritter  von  Rittershain  (1820-83),  of  Lemberg,  graduated 
at  Prague  (1844),  where  he  was  for  twenty  years  courtroom  and  prison 
physician,  became  head  physician  to  the  Foundling  Asylum  (1865),  and 
professor  extraordinarius  of  pediatrics  (1865-80).  In  1874,  he  erected 


THE  NINETEENTH  CENTURY 


97 


i special  pediatric  clinic  attached  to  the  Foundling  Asylum.  He  wrote 
on  the  pathology  and  therapy  of  rickets  (1863),  temporary  hemophilia 
in  the  newborn  (1871),  mental  activity  ( Geistesleben , 1871),  exfoliative 
dermatitis  in  infants  (1878),  the  hygiene  of  childhood  (1878),  and 
luring  1865—78,  issued  his  clinical  and  statistical  reports  from  the 
Foundling  Hospital  at  Prague,  which  are  famous  for  their  wealth  of 
nteresting  pediatric  material.  To  the  history  of  medicine  he  made  a 


Fig.  17. — Gottfried  Ritter  von  Fig.  18. — Max  Kassowitz 

Rittershain  (1820-1883).  (Cour-  (1842-1913).  (Courtesy  of  Dr. 

tesy  ot  Dr  A.  Jacobi,  New  York.)  J.  H.  Hess,  Chicago.) 

nemorable  contribution  on  the  ancient  temple-cult  of  incubation 
(1878).  He  founded  the  Jahrbuch  fiir  Physiologic  und  Paihologie  des 
rsten  Kindesalters  (1868)  and  was  co-editor  of  its  successor,  the 
Oesterreichisches  Jahrbuch  fiir  Padiatrik  (1870-78).  Suffering  from 
pilepsy  (the  subject  of  his  graduating  thesis),  he  retired  to  Gorlitz 
a 1880,  and  died  of  an  apoplectic  stroke  on  August  20,  1883. 

Alois  Epstein  (1849-1918),  of  Kamenitz,  Bohemia,  graduated 
at  Prague  (1873),  where  he  became  professor  and  director  of  the  Pedi- 
atric Clinic  in  the  University  (1884).  He  wrote  on  jaundice  in  the 
newborn  (1880),  foundling  asylums  (1880),  duration  of  gastric 
digestion  in  infancy  (1880-87),  antiseptic  measures  in  infant  hygiene 
(1888),  cholera  infantum  (1890)  and  disorders  of  infant  nutrition 
1899).  By  rigid  asepsis  in  infant  hygiene,  Epstein,  in  fourteen  years 
reduced  the  mortality  in  the  Foundling  Asylum  at  Prague  from  30  to 
5 per  cent.  (Heubner). 

Max  Kassowitz  (1842-1913),  of  Pressburg,  Hungary,  a Vienna 
graduate  of  1863,  assisted  and  succeeded  L.  Politzer  as  director  of  the 
Vienna  Polyclinic  Institute  No.  I (1881)  and  became  professor  of 

Vol.  I — 7 


98 


HISTORY  OF  PEDIATRICS 


pediatrics  in  the  University  (1891).  He  wrote  on  hereditary  syphilis 
(1876),  rickets  (1881-86),  lectures  on  children’s  diseases  during  denti- 
tion (1892),  a treatise  on  general  biology  (1899)  and  edited  a series  of 
pediatric  contributions  (“Beitrage”)  from  his  Institute  (1891-93). 
Kassowitz  was  the  first  to  recommend  phosphorus  and  cod-liver  oil 
(. Phosphorleberthran ) in  the  treatment  of  rickets  (1883),  but  his  patho- 
logical theory  of  the  disease  has  been  abandoned. 

Alois  Monti  (1839-1909),  of  Abbiategrasso,  Lombardy,  graduated 
at  Vienna  (1862),  became  Widerhofer’s  assistant  (1862-69),  and 
eventually  professor  extraordinarius  at  the  University.  He  wrote  the 
articles  on  epidemic  cholera,  diseases  of  the  kidneys  and  suprarenal 
bodies,  and  hemorrhage  of  the  spinal  cord  in  the  Gerhardt  Handbuch 
(1878-84),  and  monographs  on  croup  and  diphtheria  in  children  (1884), 
nutrition  up  to  weaning  (1897),  disorders  of  infantile  nutrition  (1897- 
98),  visceral  diseases  in  children  (1898-1903)  and  a series  of  clinical 
lectures  on  pediatrics  (1897-1903).  With  Adolf  Baginsky,  he  was 
founder  and  co-editor  of  the  Central-Zeitung  fur  Kinderheilkunde 
(1877-79)  and  its  successor,  the  Archiv  fur  Kinderheilkunde  (1880-1909). 

Ludwig  Unger  (1848-  ) of  Marienthal,  Hungary,  a Vienna 

graduate  of  1870  wrote  on  cortical  epilepsy  (1886)  and  diffuse  insular 
sclerosis  (1887),  in  children,  published  a text-book  of  pediatrics 
(1890,  3d  ed.  1901),  and  translated  the  Regiment  of  Metlinger  (1904). 

Janos  Bokai  (1822-84),  of  Iglo,  Hungary,  graduated  at  Budapest 
(1847),  where  he  became  chief  physician  to  the  Hospital  for  Poor 
Children  (1849)  and  professor  of  pediatrics  in  the  University.  He  was 
instrumental  in  the  erection  of  a fine  children’s  hospital  of  modern 
type  at  Budapest  (1884).  He  wrote  the  monographs  on  diseases  of 
the  male  organs,  bladder  and  rectum  in  the  Gerhardt  Handbuch  (1878), 
and  was  co-editor  of  the  Jahrbuch  fur  Kinderheilkunde  (1858-84). 

In  Russia,  Karl  Rauchfuss  (1835-1915),  of  Petrograd,  physician  and 
prosector  to  the  Foundling  Asylum  (1858-68),  director  and  head- 
physician  of  the  Children’s  Hospital  (Prince  Peter  of  Oldenburg)  in 
Petrograd  (1869)  the  construction  of  which  was  superintended  by  him 
(1867-69),  also  built  the  St.  Vladimir  Children’s  Hospital  in  Moscow 
(1874-76)  and  became  pediatrist  to  the  Czar  in  1876.  He  wrote  the 
articles  on  children’s  hospitals,  diseases  of  the  larynx,  congenital 
abnormalities  and  fetal  diseases  of  the  heart  in  the  Gerhardt  Handbuch 
(1877-82),  and  a number  of  papers  on  thrombosis  of  the  pulmonary 
artery  in  infancy  (1859),  congenital  stenosis  of  the  aorta  (1860),  joint 
inflammation  in  infancy  (1863),  croup  (1885),  etc.  All  these  papers 
are  valuable  for  new  data,  and  the  historical  study  of  children’s 
hospitals  (1877)  is  perhaps  the  best  ever  written.  Rauchfuss  practiced 
the  most  rigorous  isolation  of  contagious  cases  in  his  wards,  and  was 
highly  esteemed,  both  as  specialist  and  scientific  surgeon,  in  the 
Russian  capital. 

Nil  Fyodorovich  Filatoff  * (1847-1902),  a native  of  the  Penza  Govern- 

* The  name  is  usually  spelled,  according  to  German  transliteration,  “Filatow." 
The  accent  is  thrown  upon  the  second  syllable. 


THE  NINETEENTH  CENTURY 


99 


ment,  graduated  at  Moscow  (1869)  and  after  a course  of  study  at  ' 
Vienna  and  Prague,  under  Widerhofer,  Monti,  and  Steiner,  became 
privat-docent  in  pediatrics  in  the  Moscow  Faculty  (1876)  and  pro- 
fessor in  1891.  At  the  same  time,  he  became  director  of  the  new 
Chludoff  Children’s  Hospital, 
which,  through  his  engaging 
lectures,  he  made  one  of  the 
finest  pediatric  clinics  in  the 
world.  He  wrote  a series  of 
lectures  on  infectious  diseases  in 
children  (1885-87),  a highly 
esteemed  treatise  on  the  semei- 
ology  and  diagnosis  of  children’s 
diseases  (1890) — both  frequently 
translated — and  a number  of 
shorter  pediatric  textbooks  and 
lecture-courses  on  pediatrics. 

In  his  lectures  on  infectious 
diseases  (1887,  II,  113),  he  first 
described  as  “scarlatinal  rubella” 
the  anomalous  exanthem  which 
Dukes,  in  1900,  described  as  the 
“fourth  disease”  (Filatoff-Dukes 
disease).  He  was  the  first  pres- 
ident of  the  Moscow  Pediatric 
Society  (1892)  and  was  annually 
reelected  until  his  death.  In  spite  of  his  occasional  brusquerie,  he 
was  universally  beloved  for  his  large/unselfish  unprejudiced  nature. 

Dmitri  Alexandrovich  Sokoloff  (1861-  ) has  published  a clinic  of  pleurisy 

in  children  (1906)  and  a remarkable  collection  of  photographs  of  sick  children 
(1914).  From  the  laboratory  of  the  Ivaiserin  Augusta  Victoria  Haus,  Berlin, 
came  important  studies  by  Arvo  Yllpo,  of  Helsingfors,  on  icterus  neonatorum  and 
congenital  obstruction  of  the  bile-ducts  (1913). 

In  France,  Armand  Trousseau  (1801-67),  of  Tours,  the  eminent 
clinical  lecturer  of  the  Hotel  Dieu,  performed  the  first  tracheotomy  in 
Paris  (1831),  eventually  averaging  25  per  cent,  of  recoveries  in  200 
cases,  introduced  the  well-known  diagnostic  sign  in  infantile  tetany, 
described  laryngeal  phthisis,  gastric  vertigo,  the  cutaneous  and  mucous 
diphtherias,  recreated  French  therapeutics  and  originated  thoracentesis 
in  pleurisy  (1843).  It  is  said  that  Trousseau  put  choleriform  enteritis 
on  the  pediatric  map.  His  famous  Clinique  medicate  de  VHotel  Dieu 
(1861)  did  much  for  the  specialty  of  children’s  diseases.  The  lectures 
on  scarlatina,  measles,  rubella,  mumps,  diphtheria,  aphthae,  laryngis- 
mus stridulus,  infantile  convulsions,  tetany,  whooping  cough,  incon- 
tinence of  urine,  cholera  infantum,  lactation  and  dentition,  syphilis  in 
the  newborn  and  rickets  make  up  what  is  virtually  a substantial 
pediatric  treatise  within  the  great  work  itself.  This  was  the  last  time 
that  important  pediatric  contributions  were  published  as  a subsidiary 


Fig.  19. — Nil  Feodorovich  Filatoff 
(1847-1902). 


100 


HISTORY  OF  PEDIATRICS 


portion  of  internal  medicine,  yet  never,  perhaps,  under  more  brilliant 
auspices. 

Marie-Jules  Parrot  (1839-83)  of  Excideuil  (Dordogne),  a Paris 
graduate  of  1857,  succeeded  Lorain  as  professor  of  medical  history  in 
the  Paris  Faculty  (1876),  which  chair  he  subsequently  exchanged  for 
that  of  pediatrics.  He  described  syphilitic  pseudo-paralysis  (Parrot’s 
disease)  in  the  newborn  (1872),  and  its  relation  to  rickets,  also  different 
diseases  of  the  brain  in  infancy  (1868-75).  In  his  Clinique  of  1875,  he 


Fig.  20. — Jacques-Joseph  Grancher  Fig.  21. — Victor-Henri  Hutinel 

(1843-1907).  (Courtesy  of  Dr.  John  (1849-  ). 

John  S.  Fulton,  Baltimore,  Md.) 


introduced  the  concept  “athrepsia,”  a general  state  of  malnutrition, 
as  the  deep,  underlying  cause  of  most  infantile  diseases,  which  has 
been  latterly  ridiculed  by  Hutinel.  In  1881,  Parrot,  Tarnier,  Fournier 
and  others  attempted  infant  nutrition  (particularly  in  congenital 
syphilis)  by  direct  suckling  from  the  udders  of  the  goat,  as  depicted  in 
the  art  of  antiquity  and  recommended  by  Raulin  (1769).  As  shown  by 
Marfan,  the  merits  of  the  method  were  “possible  but  not  probable,” 
i.e.,  it  may  bring  on  rickets  and  has  otherwise  no  special  advantage. 

Henri-Louis  Roger  (1809-91)  of  Paris,  where  he  took  his  medical 
degree  (1839),  was  physician  to  the  Hopital  Sainte-Eugenie  (1860-75), 
and  wrote  a treatise  on  auscultation  (with  J.  B.  P.  Barth  1850),  a 
treatise  on  the  semeiology  of  infantile  diseases  (1864),  and  a series  of 
Recherches  cliniques  on  chorea,  rheumatism,  heart  disease,  syphilis  and 
whooping  cough  in  children  (1867-83).  He  described  the  congenital 
interventricular  communication  known  as  “Roger’s  disease.” 

Jacques-Joseph  Grancher  (1843-1907),  of  Paris,  famed  for  his 


THE  NINETEENTH  CENTURY 


101 


graduating  dissertation  on  the  unity  of  phthisis  (1872),  wrote  much  on 
pulmonary  tuberculosis  (1872-90),  a series  of  papers  on  isolation  and 
medical  antisepsis  in  the  Hopital  des  enfants  (1889-90),*  and  collab- 
orated with  Comby  and  Marfan  in  a massive  Traite  des  maladies  de 
Venfance,  in  five  volumes  (1897,  2d  ed.,  1904-5).  At  the  Hopital 
des  enfants  malades,  Grancher  introduced  surgical  asepsis  in  the 
children’s  wards  (1889),  each  infectious  case  being  “boxed”  in  a quad- 
rangular wire  cage,  which  no  one  was  allowed  to  enter  except  in  a 
surgical  gown. 

Victor-Henri  Hutinel  (1849-  ),  of  Chatillon-sur-Seine,  gradu- 

ated at  Paris  with  a dissertation  on  disturbances  of  the  venous 
circulation  in  children  (1877),  became  professor  of  clinical  pediatrics 
in  the  Paris  Faculty,  and  succeeded 
Grancher  at  the  Hopital  des  enfants 
malades.  At  the  Hopital  des  enfants 
assistes,  Hutinel  replaced  the  wire 
screens  ( grillages ) of  Grancher  by 
transparent  glass  screens  with  doors 
and  the  usual  aseptic  ritual  of  entry 
and  egress  (1894).*  These  isolation 
cubicles  were  widely  imitated. 

He  wrote  on  diseases  of  the  intes- 
tines (1907),  introduced  the  excellent 
Elements  of  Infantile  Semeiology  by 
Fernandes  Figueira  (1903)  and  edited 
the  five-volume  system  of  pediatrics 
entitled  Les  Maladies  des  Enfants 
(1909).  He  is  also  co-editor  of  the 
Archives  de  mededne  des  enfants 
(1898-1922). 

Jules  Comby  (1853-  ),  of 

Pompadour  (Correze),  a Paris  gradu- 
ate of  1881,  and  chief  physician  to  the  Hopital  des  enfants  malades,  is 
the  author  of  monographs  on  zona  (1889),  rickets  (1892),  mumps 
(1893),  pulsatile  empyema  (1895)  and  diathetic  diseases  (1901)  in 
children,  a pediatric  treatise  (1892,  5th  ed.,1907),  a pediatric  formulary 
(1894)  and  pocket  formulary  (1901),  a treatise  on  infantile  therapeutics 
(1900)  and  a series  of  pediatric  consultations  (1910).  He  is  editor  of 
La  Mededne  Infantile  (1894)  and  co-editor  of  the  Archives  de  mededne 
des  enfants  (1898-1922)  and  the  five-volume  Traite  (1897)  mentioned 
above. 

Gaston-Felix- Joseph  Variot  (1855-  ),  of  Demiguy  (Saone-et 

Loire),  graduated  at  Paris  with  a thesis  on  leucocythemia  (1882), 
became  physician  to  the  Hopital  des  enfants  malades  and  professor  of 
infantile  surgery  in  the  Paris  Faculty  and  is  author  of  treatises  on  the 
formed  elements  of  the  blood  (1886),  household  pediatrics  (1892), 
diphtheria  and  serum  therapy  (1898)  and  infant  hygiene  (1908,  1910). 

* Grancher,  Rev.  d’hyg.,  Paris,  xi  (1889),  p.  204;  xii  (1890),  p.  495. 


Fig.  22. — Jules  Comby  (1853-  ). 


102 


HISTORY  OF  PEDIATRICS 


He  translated  the  Goodhart  pediatric  treatise  (1895)  and  edited  the 
Journal  de  clinique  et  de  therapeutique  infantiles  (1893-94).  At  his 
goutte  de  lait  at  Bellevue,  he  did  much  philanthropic  work. 

Bernard-Jean-Antonin  Marfan  (1858-  ),  of  Castelnaudary 

(Aude),  graduated  at  Paris  (1887)  and  became  chief  of  the  clinic  in  the 
Hopital  Necker  and  professeur  agrege  (in  the  Paris  Faculty  1892). 
He  is  the  author  of  works  on  infantile  eczema  (1894),  typhoid  fever 
(1894)  and  peritonitis  (1894)  in  children,  congenital  infections  in  the 
newborn  (1897),  infant  nutrition  (1899),  infantile  gastro-enteritis 
(1900),  diphtheria  and  diseases  of  the  air-passages  (1905),  diseases  of 
the  respiratory  diseases,  in  the  Bouchard  system  (1892),  collaborated 
with  Grancher  and  Comby  in  their  pediatric  system  of  1897,  and  is 
editor  of  Le  Nourris.son  (1913-22).  In  1900-1902,  he  demonstrated 
and  investigated,  with  Charles  Gillet,  the  oxidizing  and  fat-splitting 
ferments  in  milk  (oxydase  and  lipase).* 

In  Great  Britian,  the  obstetrician  Fleetwood  Churchill  [1808-78],  of 
Nottingham,  England,  who  graduated  M.D.  at  Edinburgh  (1831)  and 
practiced  in  Dublin,  published  a large  treatise  on ’diseases  of  children 
(1850),  which  was  popular  and  was  edited  in  America  by  William  V. 
Keating. 

Sir  James  Frederic  Goodhart  [1845-1916],  of  London,  an  Aberdeen 
graduate  of  1873,  became  assistant  physician  (1877)  and  physician 
(1886-98)  to  Guy’s  Hospital,  where  he  did  much  post-mortem  work 
and  lectured  on  pathology  to  the  medical  school.  He  was  also  patho- 
logical assistant  to  the  Museum  of  the  Royal  College  of  Surgeons, 
prepared  the  Supplementary  Catalogue  (1879)  and  assisted  Sir  James 
Paget  in  preparing  the  new  edition  of  the  whole  catalogue  (1885).  In 
1885,  he  also  published  his  Students’  Guide  to  the  Diseases  of  Children, 
which  reached  its  tenth  edition  in  1913  and  was  translated  into  French. 
In  the  later  English  editions,  Goodhart  was  assisted  by  Still,  while  the 
American  editions  were  edited  by  Louis  Starr.  This  book,  the  work 
of  an  expert  pathologist  and  clinician,  has  been  highly  esteemed  as 
confining  itself  to  diseases  peculiar  to  children  and  not  attempting  to 
cover  the  whole  of  internal  medicine. 

Henry  Ashby  (1845-1908),  of  Manchester,  a medical  graduate  of 
the  University  of  London  (1878),  was  a forerunner  of  the  brilliant  group 
of  English  public  health  officers  who  have  done  so  much,  in  recent 
years,  for  infant  welfare.  In  1879,  he  was  appointed  physician  to  the 
Manchester  (Pendlebury)  Hospital  for  Sick  Children  (168  beds), 
which  he  served  for  nearly  thirty  years.  During  1880-1908,  he  was 
lecturer  on  pediatrics  to  Owens  College  and  the  University  of  Man- 
chester. He  did  much  for  popular  propagandism  in  aid  of  infant 
welfare  and  a pure  milk  supply,  gave  important  evidence  before  the 
Interdepartmental  Committee  on  Physical  Deterioration  (1904), 
examined  the  feeble-minded  (1900)  for  the  Manchester  Schoolboard, 
and  the  epileptics  (1915)  for  a Royal  Commission,  and  established  the 
Residential  School  for  65  epileptic  children  in  Swinton  Park.  Its 
* Marfan  and  Gillet,  Monatsschr.  f.  Kinderheilk.,  i (1902-3),  pp.  57-63. 


THE  NINETEENTH  CENTURY 


103 


success  was  entirely  due  to  his  efforts.  He  published  a useful  manual 
of  “Notes  on  Physiology  (1878,  8th  ed.,  1910),  popular  lectures 
on  infant  feeding  (1878-82),  Health  in  the  Nursery  (1898),  and  with 
George  Arthur  Wright,  consulting  surgeon  to  the  Royal  Infirmary 
Manchester,  a treatise  on  the  medical  and  surgical  diseases  of  children 
(1889,  5th  ed.,  1905),  which  was  signalized  by  Jacobi  as  the  first  in 
which  a surgeon  and  pediatrist  collaborated  to  produce  a work  of 
unusual  merit. 


Sir  Thomas  Barlow  (1845-  ),  consulting  physician  to  the  Hos- 

pital for  Sick  Children,  London,  and  president  of  the  Royal  College  of 
Physicians  (1910-15),  wrote  the  classical  paper  on  infantile  scurvy 


Fig.  23. — Henry  Ashby  (.1845-1908).  Fig.  24. — George  Frederic  Still  (1868-  ) 


or  “Barlow’s  disease”  (1882),*  a condition  which  had  already  been 
vaguely  outlined,  in  connection  with  infantile  rickets,  by  Glisson 
(1650)  and  J.  O.  L.  M oiler  (1856-60).  Barlow  has  also  written 
on  pleurisy  (1877)  and  rheumatism  (1883)  in  childhood,  and  collabor- 
ated with  Goodhart  and  Macnamara  in  the  Collective  Investigation 
Committee’s  reports  on  acute  rheumatism  and  inherited  syphilis 
(1882). 

George  Frederic  Still  (1868-  ),  professor  of  pediatrics  in  Kings 

College,  London,  and  physician  to  the  Great  Ormond  Street  and  other 
children’s  hospitals,  made  his  mark  in  internal  medicine  by  his  original 
description  of  arthritis  deformans  in  children  or  “Still’s  disease” 
(1896). f He  wrote  the  treatise  on  rickets  in  Osier’s  Modern  Medicine 
(1907),  edited  the  Goodhart  treatise  (1905-10)  and  Charles  West’s 

* Barlow,  Med.  Chir.  Tr.,  London,  lxvi  (1882-3),  pp.  159-219. 
t Still,  Med. -Chir.  Tr.,  London,  lxxx  (1896-7),  pp.  47-59,  3 ph 


104 


HISTORY  OF  PEDIATRICS 


tract  on  nursing  (1908)  and  has  published  an  admirable  treatise  on  the 
“Common  Disorders  and  Diseases  of  Childhood”  (1909,  2d  ed.,  1912). 

Sir  Arthur  Newsholme,  late  Medical  Officer  of  the  Local  Govern- 
ment Board,  associate  editor  of  the  Journal  of  Hygiene,  and  author 
of  works  of  Vital  Statistics  (1889),  the  natural  history  and  affinities 
of  rheumatic  fever  (1895),  epidemic  diphtheria  (1898),  the  causes  of 
the  reduction  in  death  rate  of  phthisis  (1906)  has  rendered  signal 


Fig.  25. —Janet  Lane-Claypon.  Fig.  26. — Job  Lev/is  Smith  1S97). 


service  to  preventive  pediatrics  through  his  five  reports  to  the  Local 
Government  Board  on  infant,  child  and  maternal  mortality  (1910-16), 
which  have  established  the  multiplex  causation  of  infant  mortality,  its 
importance  as  a true  index  of  the  adult  health  of  a community  and  the 
necessity  of  manifold  devices  to  combat  the  evil. 

Janet-Elizabeth  Lane-Claypon,  a graduate  of  the  London  School 
of  Medicine  for  Women,  and  of  University  College,  was  assistant 
Medical  Inspector  of  the  Local  Government  Board  (1912-16),  and  is 
perhaps  the  most  remarkable  living  physician  of  her  sex.  In  1906. 
she  performed,  with  Starling,  one  of  the  fundamental  experiments  in 
endocrine  doctrine,  showing  that  section  of  the  nerves  supplying  the 
mammary  gland  does  not  inhibit  lactation,  and  that  after  section  of 
the  spinal  cord  in  the  rabbit,  parturition  and  lactation  proceed  as 
ordinarily.  Her  report  to  the  Lister  Institute  on  the  status  of  child 
welfare  in  Europe  and  her  investigations  of  milk  were  of  basic  import- 
ance. She  is  the  author  of  three  recent  books  on  Milk  and  its  Hygiene 
(1916),  The  Child  Welfare  and  Movement  (1920)  and  The  Hygiene 
of  Women  and  Children. 


THE  NINETEENTH  CENTURY 


105 


John  Thomson,  of  Edinburgh,  translated  Henoch’s  V orlesungen 
(1889),  wrote  the  monographs  on  hemorrhage  in  the  newborn  in 
Allbutt’s  System  of  Medicine  (1909),  a useful  Guide  to  the  Clinical 
Examination  and  Treatment  of  Sick  Children  (1898),  which  has  been 
translated  into  Russian  (1801);  and  papers  on  congenital  obliteration 
of  the  bile-ducts  (1891-92)  congenital  gastric  spasm  (1897)  and 
causation  on  congenital  stridulism  (1901). 

David  Forsyth,  physician  to  the  Evelina  Hospital  for  Sick  Children, 
London,  is  the  author  of  “Children  in  Health  and  Disease,”  a study  of 
child-life  (1909),  lectures  on  medical  diseases  for  nurses  (1913),  a book 
on  psychoanalysis  (1913)  and  a fascinating  history  of  infant  feeding 
from  Elizabethan  times  (1911). 

Leonard  Findlay  of  Glasgow  (M.D.,  1904)  is  the  author  of  studies 
on  the  intestine  as  a pathway  of  infection  for  the  tubercle  bacillus 
(1913),  and  the  etiology  of  rickets  (1916).  The  lectures  on  Diseases 
of  the  Long  Bones  in  Children  (1894)  by  the  late  Thomas  Pickering 
Pick  (1841-1919)  deserve  especial  mention  here. 

The  best  known.  American  pediatrist  of  his  time,  with  the  single 
exception  of  Jacobi,  was  Job  Lewis  Smith*  (1827-97),  of  Spafford,  New 
York,  who  graduated  at  Yale  (1849)  and  began  the  study  of  medicine  at 
Buffalo  Medical  College  (1850)  under  the  preceptorship  of  Austin 
Flint,  who  made  him  an  interne  in  hospital  before  he  took  his  medical 
degree  at  the  College  of  Physicians  and  Surgeons,  New  York  (1853). 
Smith  became  physician  to  many  hospitals,  was  clinical  professor 
of  pediatrics  in  Bellevue  Hospital  Medical  College  and  practised 
uninterruptedly  in  New  York  City  for  nearly  fifty  years  (1853-97). 
In  1869,  he  published  his  Treatise  on  the  Diseases  of  Infancy  and 
Childhood,  based  upon  his  own  clinical  experience  and  pathological 
findings,  which  passed  through  eight  editions  (1869-96),  was  trans- 
lated into  Spanish,  and  is  still  esteemed  as  a solid,  reliable  work. 
During  1854-96,  he  made  some  160  contributions  to  medical  periodicals 
and  systems.  He  was  a man  of  modest  nature,  and  gentle,  unworldly 
demeanor,  a friend  of  the  unfortunate,  giving  up  a large  part  of 
his  time  to  the  poor,  frequently  without  compensation.  He  took  up 
pediatrics  only  after  a broad  experience  in  general  practice,  and  once 
resented  a slurring  imputation  with  the  warm  retort  “Yes,  perhaps  a 
specialist,  but  I trust  something  more.”  The  countenance  of  J.  Lewis 
Smith,  the  typical  family  doctor  of  the  past,  is  expressive  of  a genera- 
tion, less  metallic,  less  conceited,  more  gentle,  modest,  and  considerate 
of  others,  than  our  own.  These  old-fashioned  American  faces  we  shall 
not  see  again. 

In  the  year  1853,  there  came  to  New  York  one  who  was  destined  to 
exert  a profounder  influence  upon  American  pediatrics  than  any  other 
physician  of  the  present  or  past.  This  was  Abraham  Jacobi  (1830—1919,) 
of  Hartum,  Westphalia,  who  graduated  in  medicine,  with  a Latin  dis- 

* For  the  life  of  J.  Lewis  Smith,  see  the  Memorial  Notices  by  Ellsworth  Eliot, 
Tr.  New  York  Acad.  Med.  (1896—1901),  pp.  220—231,  and  John  Stradv,  Tr.  New 
York  State  Med.  Assoc.,  N.  Y.,  xiv  (1897),  pp.  524-538  (with  bibliography). 


106 


HISTORY  OF  PEDIATRICS 


sertation  at  Bonn  (1851)  and  during  the  next  two  years  was  held  in  de- 
tention in  German  fortresses  at  Cologne  and  Minden  for  revolutionary 
activities  and  “lese  majeste.”  Escaping  to  England,  he  eventually 
reached  Boston  and  commenced  practice  at  20  Howard  Street,  New 
York.  One  year  after,  he  invented  a mirror  laryngoscope  of  his  own, 

which,  unfortunately,  he  did  not 
either  patent  or  make  public  before 
the  announcement  of  Manuel 
Garcia’s  invention  (1855);  but  by 
1857,  he  was  lecturing  on  pediatrics 
in  the  College  of  Physicians  and 
Surgeons  of  New  York,  and  thus, 
as  Adams  says,  “ pressed  the  button 
which  set  the  pediatric  clinic  in 
motion.”  Three  years  later,  he 
was  appointed  to  the  first  special 
chair  of  diseases  of  children  in  the 
New  York  Medical  College  (1860- 
64).  In  1865,  he  accepted  the 
same  “ clinical  ” chair  in  the  Medical 
Department  of  the  University  of 
New  York,  and  in  1870,  he  became 
clinical  professor  of  pediatrics  in 

the  Medical  Department  of  Col- 
Fig.  27,-Abraham  Jacobi  (1830-1919).  umbia  CoUege  (1870-99).  All  in 

all,  he  taught  pediatrics  in  New 
York  for  nearly  half  a century  (1857-99).  With  the  exception  of 
J.  Lewis  Smith,  he  was  the  only  American  practitioner  who  cultivated 
pediatrics  at  this  time.  With  the  foundation  of  the  new  pediatric 
chair  in  1860,  the  faculty  of  New  York  Medical  College  established  a 
pediatric  clinic,  with  extensive  bedside  instruction  (1862-64).  Thus 
bedside  teaching  in  this  country  was  first  associated  writh  pediatric 
teaching,*  even  before  internal  medicine.  In  1858,  Jacobi  published 
his  first  paper  on  colonic  intussusception  in  infancy,  which  was  followed 
by  a paper  on  infantile  rickets  (on  premature  closure  of  the  fontanelles 
and  cranial  sutures)  and  a volume  of  “Contributions  to  Midwifery 
and  Diseases  of  Women  and  Children”  (1859)  by  Jacobi  and  Emil 
Noeggerath.  This  was  followed  by  his  initial  course  of  lectures  on 
Diseases  of  the  Larynx  (1859).  He  wrote  much  on  diphtheria  during 
1860-80,  and  published,  in  succession,  books  on  Dentition  and  its 
* “If  ever  you  will  recall  for  yourself  and  your  friends  the  first,  the  very  first 
beginning  of  medical  bedside  instruction  in  America,  please  tell  them  of  the  small 
college  on  East  13th  Street — I believe  118- — which  had  to  close  its  doors  in  1864, 
a victim  of  the  Civil  War,  which  deprived  us  of  all  of  our  Southern  students. 
That  is  part  of  your  American  medical  history^  worth  remembering.  I was  per- 
mitted to  be  quite  active  in  tins  successful  enterprise,  and  utilized  my  opportuni- 
ties in  preferring  my  pets,  the  young  patients.  My  later  experience  will  teach 
you  that  successive  bedside  teaching  was  almost  exclusively  pediatric.  Thus 
pediatry  was  the  example  of  giving  correct  medical  instruction.  Jacobi,  Arch. 
Pediat.,  New  York,  xxxiv  (1917),  p.  10. 


THE  NINETEENTH  CENTURY 


107 


Derangements  (1862),  Infant  Diet  (1872,  1874,*  1878),  Diphtheria f 
(1876,  3d  ed.,  1903),  the  Intestinal  Diseases  of  Infancy  and  Childhood 
(1887),  Diseases  of  the  Thymus  Gland  (1889),  Therapeutics  of  Infancy 
and  Childhood  (1896,  2ded.,  1903)  and  a series  of  clinical  lectures  (steno- 
graphed, 1893).  With  Emil  Noeggerath,  he  was  the  founder  and 
editor  of  the  American  Journal  of  Obstetrics  (1868-71).  To  the  Ger- 
hardt  Handbuch,  he  contributed  monographs  on  the  care  and  hygiene 
of  children  (1876,  2d  ed.,  1882),  diphtheria  (1877),  and  dysentery 
(1877).  The  first  of  these,  written  with  force,  fire  and  a vast  amount 
of  fine  sarcasm,  is  of  unusual  historical  and  practical  value,  by  reason 
of  its  accurate  bibliographies  (four  years  before  the  appearance  of  the 
Index  Catalogue),  its  lively  arraignment  of  the  various  artificial  foods,  its 
wholesale  denunciation  of  existing  shams  and  abuses,  and  its  rare 
common  sense.  The  treatise  on  infantile  therapeutics  (1896)  is,  in 
effect,  a treatise  on  pediatrics,  summarizing  the  author’s  views  and 
revealing  his  wide  knowledge  of  the  literature.  Jacobi’s  teaching 
in  regard  to  infant  nutrition  is  simple:  mother’s  milk  first  and  fore- 
most, raw  unpasteurized  cow’s  milk  never,  but  corrected  by  cereal 
decoctions  and  salt;  the  use  of  cane  sugar  in  place  of  milk  sugar, 
which  is  different  in  human  and  cow’s  milk  and  frequently  adulterated. 
A high  percentage  of  fat  is  adjudged  harmful,  and  a monotonous  diet  is 
especially  to  be  avoided,  as  leading  to  scurvy,  rickets  and  other  defi- 
ciency diseases.  One  by  one,  the  practical  bedside  physician  and  the 
laboratory  specialist  alike  have  come  around  to  the  substance  of  these 
views. 

During  sixty  years  of  active  practice,  Jacobi  had  written  a vast  number  of 
clinical  papers,  essays  and  public  discourses,  which  are  remarkable  for  the  subtle 
wisdom  of  long  experience,  wide  learning  which  is  never  obtruded,  and  delicate 
humor.  These  have  been  published  as  Collectanea  Jacobi  in  eight  volumes 
( 1 909) , t five  of  which  are  devoted  to  pediatrics.  Among  the  more  important  papers 
are  those  on  laryngeal  catarrh  (1859)  and  laryngismus  stridulus  (1869),  craniotabes 
(1871),  masturbation  and  hysteria  in  infants  (1875),  rickets  (1885),  acute  catarrhal 
and  pseudo-membranous  laryngitis  (1885),  stomatitis  neurotica  chronica  (1894), 
the  muscles  of  rachitic  infants  (1894),  nephritis  of  the  newborn  (1896),  milk  sugar 
in  infant  feeding  (1901)  and  the  memorable  discourse  “Non  nocere”  (1894).  To 
the  history  of  pediatrics,  Jacobi  has  contributed  several  important  papers,  notably 
his  history  of  American  pediatrics  before  1800  (1902),  his  St.  Louis  address  (1904), 
pediatrics  in  the  United  States  {Baginsky -Festschrift,  1913),  the  history  of  cerebro- 
spinal meningitis  in  America  (1905)  and  the  history  of  pediatrics  in  New  York, 
City  (1917);  to  the  history  of  medicine,  his  memorial  notices  of  Ernst  Kracko- 
wizer  (1875),  Virchow  (1881-1901),  Austin  Flint  (1886),  Carl  Gerhardt  (1902), 
valuable  histories  of  nursing  (1883),  therapeutics  (1905),  medical  libraries  (1906), 
American  medicine  (1900),  German  medical  teaching  (1901)  and  his  letters  on 
the  condition  of  American  medicine  (1909). 

The  later  writings  of  Jacobi  are  characterized  by  a vein  of  irony  of 
the  most  delicate  and  elusive  type.  There  is  often  a quaint  surprise  in 
every  sentence.  The  mirthful  goddess,  quam  Jocus  circumvolat,  is 
seldom  absent  from  his  pages,  and  this  omnipresent  sense  of  humor  has 

* Revised,  enlarged  and  adapted  to  popular  use  by  Mary  Putnam  Jacobi. 

f Translated  into  Italian  by  Vincenzo  Meyer,  Naples  (1884). 

j Edited  by  William  J.  Robinson,  New  York  (1909). 


108 


HISTORY  OF  PEDIATRICS 


endeared  him  particularly  to  Americans.  A banquet,  with  presenta- 
tion of  a loving-cup  and  the  publication  of  a Festschrift,  was  held,  in 
honor  of  his  seventieth  birthday,  on  May  6,  1900.  As  our  first  teacher 
and  professor  of  pediatrics,  as  the  founder  of  bedside  instruction  in 
this  country,  as  the  founder  of  the  pediatric  sections  of  the  American 
Medical  Association  and  the  New  York  Academy  of  Medicine,  as 
the  first  president  of  the  American  Pediatric  Society,  he  became 
through  years  of  dignified  labor  and  distinguished  honor,  the 
leader  and  the  Nestor  of  his  profession  in  the  United  States.  He  could 
have  had  Henoch’s  chair  when  Henoch  died,  but  declined  it  to 
remain,  in  his  own  phrase,  “a  bridge  between  European  and  American 
pediatrics.”  A valued  friend  of  Billings,  it  was  Jacobi  who  secured  the 
Congressional  appropriations  for  printing  the  Index  Catalogue.  In 
advanced  age,  he  remained  ever  true  to  the  ideals  of  his  fiery  youth. 
Not  a line  in  his  writings  that  does  not  reveal  the  man  who  values  the 
truth  above  all  things,  who  cares  more  for  the  truth  than  for  him- 
self; not  a public  utterance  but  is  informed  with  the  highest  type  of 
civic  and  moral  courage.  And  it  was  under  the  guidance  of  a man  of 
this  inherent  noblesse  of  mind  and  character  that  American  pediatrics 
has  prospered  to  its  present  fair  estate. 

Intubation  of  the  larynx  became  a permanent  rational  procedure  in 
pediatrics  through  the  labors  of  Joseph  O’Dwyer  (1841-98),  of  Cleve- 
land, Ohio,  who  came  to  New  York  in  1864,  graduated  in  medicine  at 
the  College  of  Physicians  and  Surgeons  (1866),  served  as  interne  in  the 
Charity  Hospital,  began  practice  in  1868,  became  connected  with  the 
New  York  Foundling  Asylum  (1873),  the  Willard  Parker,  St.  Vincent’s 
and  the  Foundling  Hospitals,  and  was  president  of  the  American 
Pediatric  Society  (1880).  In  1880,  he  began  to  think  about  the  possi- 
bilities of  intubation,  which  had  been  neglected  after  the  rebuffs 
encountered  by  Bouchut’s  idea  of  tubage  (1858).  In  1885,  he  began 
publishing  reports  of  intubation  in  croup  and  chronic  laryngeal 
stenosis,  and  by  1887,  his  claims,  based  upon  records  of  hundreds  of 
well  authenticated  cases,  were  recognized  by  the  Medical  Society  of 
New  York  (State)  and  the  New  York  Academy  of  Medicine  (Jacobi 
presiding).  Prior  to  this  time,  tracheotomy  had  been  the  procedure  in 
laryngeal  obstruction,  in  the  practice  of  Ernst  Krackowizer,  Jacobi, 
Roth,  Voss  and  others.  During  1860-87,  Jacobi  performed  tracheot- 
omy over  700  times  and  assisted  in  more  than  2000  cases.  “After 
1887,”  he  says,  “I  rarely,  ever  operated,  and  my  friends  stopped 
tracheotomy  when  O’Dwyer  taught  us  all  intubation.”*  O'Dwyer’s 
work  was  taken  up  with  enthusiasm  by  Hutinel  (Paris),  Bokai  (Buda- 
pest), Concetti  (Rome)  and  Rauchfuss  (Petrograd) . He  himself  taught 
intubation  with  success  in  the  New  York  schools.  His  obstetric  prac- 
tice was  large,  covering  over  3000  confinements,  but  the  death  of  his 
wife  and  other  worries  connected  with  over-work,  insomnia  from  night - 

* Jacobi,  Arch.  Pediat.,  New  York,  xxxiv  (1917),  pp.  5—6.  For  a full  history  of 
O’Dwyer’s  work,  see  W.  P.  Northrup,  Med.  Rec.,  New  York,  lxv  (1904),  pp. 
561-564. 


THE  NINETEENTH  CENTURY 


109 


•calls,  and  captious  criticisms  of  his  invention,  finally  broke  down  his 
health,  and  he  died  from  thrombosis  of  the  cerebellar  arteries  with 
secondary  meningitis  on  January  7,  1898.  His  temperament  was  of 
the  retiring,  diffident  kind  which  endures  great  internal  suffering  from 
senseless  criticism  and  blundering  opposition.  “ Whenever  the  records 
of  diphtheria  will  be  written  up,”  says  Jacobi,  “there  will  be  four 
names  at  the  head  of  those  who  deserve  the  places  of  honor,  Breton- 
neau,  Trousseau,  Behring  and  O’Dwyer.”* 

Another  pioneer  in  pediatrics  as  a specialty,  detached  from  internal 


Fig.  28. — Joseph  P.  O'Dwyer  Fig.  29. — William  Perry 

(1841-1898).  Northrup  (1851-  ). 

medicine,  is  William  Perry  Northrup  (1851-  ),  of  Peterboro,  N.  Y., 

who  graduated  M.D.  at  the  College  of  Physicians  and  Surgeons,  New 
York,  1878,  and  became  professor  of  pediatrics  in  University  and 
Bellevue  Hospital  Medical  College  (1896).  He  performed  the  largest 
number  of  infantile  autopsies  in  his  period.  He  edited  the  American 
edition  of  Ashby  and  Wright  (1893)  and  has  written  on  emphysema 
and  pulmonary  abscess  after  whooping  cough  (1883),  pneumonia 
(1889-97),  sclerema  (1890),  infantile  scurvy  (1890-95)  and  on  the  open 
air  treatment  of  pneumonia  by  means  of  roof  wards  and  roof  gardens 
over  private  houses,  of  which  he  has  been  a prominent  advocate. 

Samuel  Shugert  Adams  (1853-  ),  of  Washington,  D.  C., 

graduated  in  medicine  at  the  University  of  Georgetown  (1879),  where 
lie  has  been  a professor  of  medicine  and  pediatrics  since  1898.  He  has 
been  a prominent  pioneer  in  his  specialty  and  is  the  leading  pediatrician 
in  the  national  capital.  He  has  written  on  strabismus  convergens  after 
diphtheria  (1884),  sudden  death  in  diphtheria  (1884),  dentition  (1889), 
typhoid  in  infancy  (1895),  temporary  insanity  following  typhoid 
* Jacobi,  Pediatrics,  New  York  & London,  v (1898),  p.  96,  147. 


110 


HISTORY  OF  PEDIATRICS 


(1896),  and  other  subjects.  His  presidential  address  before  the 
American  Pediatric  Society  (1897),  of  which  he  was  secretary  for  25 
years  (1891-1916),  is  a breezy  and  discriminating  review  of  American 
pediatric  literature  between  1789  and  1897,  a most  valuable  and 
readable  historical  summary. 

John  M.  Keating  (1852-93),  of  Philadelphia,  a graduate  of  the 
University  of  Pennsylvania  (1873),  and  practitioner  of  pediatrics  and 
gynecology,  was  the  author  of  “A  Mother’s  Guide  ” (1881),  Diseases  of 
the  Heart  and  Circulation  in  Infancy  and  Adolescence  (with  W.  A. 


Fig.  30. — Samuel  Shugert  Adams  Fig.  31. — Louis  Starr  (1849-  ). 

(1853-  ). 


Edwards,  1888),  Mother  and  Child  (with  E.  P.  Davis,  1893),  and  in 
1890-91  published  a Cyclopedia  of  the  Diseases  of  Children  by  many 
authors,  which  was  the  earliest  cooperative  American  work  of  the  kind, 
and  did  much  to  stimulate  interest  in  this  specialty. 

Louis  Starr  (1849-  ),  of  Philadelphia,  a graduate  of  the  Univer- 

sity of  Pennsylvania  (1871),  where  he  became  clinical  professor  of 
pediatrics  (1884-90) ; is  the  author  of  works  on  the  digestive  disorders, 
of  infancy  and  childhood  (1886,  3d  ed.,  1901),  the  Hygiene  of  the 
Nursery  (1888,  8th  ed.,  1913),  Diets  for  Infants  and  Children  (1896), 
edited  the  American  editions  of  Coodhart’s  treatise  (1885,  1889),  and 
in  1895,  edited  an  American  Text-book  of  the  Diseases  of  Children  by 
various  authors  (2d  ed.,  1899).  He  has  also  edited  the  department  of 
diseases  of  children  in  the  American  Year-book  of  Medicine  and 
Surgery. 

John  Price  Crozer  Griffith  (1856-  ),  of  Philadelphia,  a graduate 

of  the  University  of  Pennsylvania  (1881)  where  he  has  been  clinical 
professor  (1891)  and  professor  (1913)  of  pediatrics,  is  the  author  of  The 
Care  of  the  Baby  (1895,  6th  ed.,  1915),  a treatise  on  Diseases  of  Infants 
and  Children  (2  v.,  1919)  and  a large  number  of  contributions  on  clinical 
pediatrics. 


THE  NINETEENTH  CENTURY 


111 


Benjamin  Knox  Rachford  (1857-  ),  of  Alexandria,  Kentucky,  a 

graduate  of  the  Medical  College  of  Ohio,  Cincinnati  (1882),  where  he  is 
now  professor  of  pediatrics  (1901),  is  the  author  of  a treatise  on  the 
Neurotic  Disorders  of  Childhood  (1905),  a treatise  on  Diseases  of 
Children  (1912)  and  a number  of  minor  contributions. 

Henry  Koplik  (1858-  ),  of  New  York,  a graduate  of  the  College 

of  Physicians  and  Surgeons  (1881),  and  attending  pediatrist  to  Mount 
Sinai  and  other  hospitals,  discovered  the  spots  diagnostic  of  measles 


(1898),  established  the  first  milk  depot  in  the  United  States  and  is  the 
author  of  a treatise  on  the  Diseases  of  Infancy  and  Childhood  (1902, 
3d  eel.,  1912)  and  numerous  clinical  papers. 

Bernard  Sachs  (1858-  ),  of  Baltimore,  Md.,  a graduate  of 

Harvard  (1878)  and  Strassburg  (1882),  neurologist  to  Bellevue  and 
Mount  Sinai  Hospitals,  described  amaurotic  family  idiocy  (1887-96), 
the  ocular  appearances  of  which  had  been  noted  by  Warren  Tay  in 
1880  (Tay-Sachs  disease)  and  is  the  author  of  the  first  American  treat- 
ise on  the  nervous  diseases  of  children  (1895). 

Rowland  Godfrey  Freeman  (1859-  ),  of  New  York,  a graduate 

of  the  College  of  Physicians  and  Surgeons  (1886)  and  professor  of 
pediatrics  in  the  University  and  Bellevue  Hospital  Medical  School,  has 
written  much  on  the  sterilization  of  milk  (1892-96)  and  clinical  subjects, 
and  a pediatric  treatise  (1917). 

Charles  Gilmore  Kerley  (1863-  ),  of  Red  Hook,  N.  Y.,  a gradu- 

ate of  University  Medical  College  of  New  York  (1888),  lecturer  on 
Diseases  of  Children  (1897-1903)  and  professor  (1903)  at  the  New 


112 


HISTORY  OF  PEDIATRICS 


York  Polyclinic  Medical  School,  is  the  author  of  Short  Talks  with 
Young  Mothers  (1902) , a practical  and  helpful  book  on  the  Treatment  of 
Diseases  of  Children  (1907)  and  a Practice  of  Pediatrics  (1914). 

Linnaeus  Edford  LaFetra  (1868-  ) of  New  York,  associate  in 

pediatrics  in  Columbia  University  and  chief  of  the  pediatric  depart- 
ment of  Bellevue  Hospital  assisted  Henry  L.  K.  Shaw  (1873-  ) 

in  editing  the  sumptuous  translation  of  Pfaundler  and  Schlossmann’s 
Diseases  of  Children  (1908,  1912),  and  has  made  numerous  contribu- 
tions to  clinical  pediatrics. 

Hermann  Bernard  Sheffield  (1871-  ),  of  New  York,  is  the  author  of  a 

pediatric  treatise  (1911),  3d  ed.,  1916),  the  Baby’s  Record  of  Health  (1913), 

the  Backward  Baby  (1915)  and  trans- 
lated E.  Graetzer’s  Practical  Pediatrics 
( 1 905 j . Other  American  text  books  have 
been  written  by  John  Madison  Tay- 
lor (1855-  ) and  William  H.  Wells, 

of  Philadelphia  (1898,  Italian  transla- 
tion, 1903)  and  Charles  Hunter  Dunn 
(1875-  ),  of  Boston  (1917). 

In  Canada,  Alexander  Blackader 
(1847-  ),  professor  of  pharma- 

cology, therapeutics  and  pediatrics 
in  McGill  University,  Montreal, 
has  made  several  contributions  to 
clinical  pediatrics. 

Apart  from  the  pediatric  treatises 
already  recorded,  we  may  mention  those 
of  Eustache  Smith  (i868),  E.  Ellis 
(1869),  C.  H.  Goodwin  (1883),  Angel 
Money  (1884),  James  Carmichael  (1892) 
and  George  M.  Tuttle  (1899)  in  England; 
Jules  Beclard  (1852),  Joachim  Giraldes 
(1869),  D’Espine  and  Pacot  (1877),  C.  L. 
Cadet  de  Gassicourt  (1880-84)  and  Pierre  Nobecourt  (1907)  in  France;  G.  A. 
Braun  (1862),  A.  Stossel  (1875),  A.  von  Huttenbrenner  (1876),  E.  Graetzer  (1891) 
in  Germany;  Andrea  Pasquali  (1873-6),  and  E.  Copasso  (1892)  in  Italy;  Francisco 
Criado  y Aguilar  (1884)  in  Spain;  I.  V.  Troitzy  (1892-3)  in  Russia:  and  S.  Miwa 
(1915)  in  Japan. 

Of  original  descriptions  of  disease,  may  be  mentioned  those  of  bronchitis 
by  Charles  Badham  (1808)  appendicitis  by  James  Parkinson  (1812)  and  Louyer- 
Villermay  (1824),  laryngismus  stridulus  by  John  Clarke  (1815),  achondroplasia 
by  M.  H.  Romberg  (1817),  hay  fever  by  John  Bostock  (1819),  asthma  thymicum 
and  thymus  death  by  Kopp  (1830),  A.  Friedleben  (1858)  and  A.  Paltauf  (1889), 
osteopsathyrosis  by  J.  Lobstein  (1833),  exophthalmic  goitre  by  C.  A.  Basedow 
(1840),  pituitary  obesity  by  B.  Mohr  (1840),  acute  fatty  degeneration  in  the  new- 
born by  Ludwig  von  Buhl  (1861-64),  adenoid  vegetations  by  Hans  Wilhelm  Meyer 
(1868),  syphilitic  pseudo-paralysis  of  infants  by  M.  J.  Parrot  (1872), infantile  purpura 
by  E.  Henoch  (1872),  “fat-diarrhea”  by  Demme  (1874-77)  and  Biedert  (1879),  mas- 
toiditis by  F.  Bezold  (1877),  cyanotic  hemoglobinuric  jaundice  by  Franz  von  Winckel 
(1879),  splenic  anemia  by  G.  Banti  (1882),  infantile  scurvy  by  Sir  Thomas  Barlow 
(1882),  periodic  vomiting  by  Samuel  Gee  (1882)  and  Ernst  von  Leyden  (1882), 
megacolon  by  H.  Hirschsprung  (1887),  pseudo-rachitic  osteoporosis  by  S.  Miwa 
and  Stoeltzner  (1898),  fourth  disease  by  N.  F.  Filatoff  (1887)  and  C.  Dukes  (1900). 

Of  the  ’ lanv  diagnostic  and  therapeutic  devices  now  employed  in  pediatrics, 


THE  NINETEENTH  CENTURY 


113 


is  only  necessary  to  mention  Laennec’s  stethoscope  (1819),  thoracentesis,  per- 
. :cted  by  Trousseau  (1843),  H.  I.  Bowditch  (1852),  Dieulafoy  (1869-72)  and 
Gstlander  (1879),  ether  anesthesia  (1846-47),  Helmholtz’s  ophthalmoscope  (1851), 
anuel  Garcia’s  laryngoscope  (1855,),  the  methods  of  treating  asphyxia  neona- 
rum  of  H.  A.  Pagenstecher  (insufflation,  1856)  and  B.  S.  Schultze  (swinging, 
;71),  the  hypodermic  syringe  of  C.  G.  Pravaz  (1851-53),  the  developments  in 
urgery  of  the  mastoid  and  middle  ear  by  Schwartze  and  Eysel  (1873),  Zaufal 
; 7884),  Kiister  (1889)  and  Stacke  (1890-97),  Koch’s  tubercle  bacillus  (1881)  and 
berculin  (1890),  Ehrlich’s  diazo-reaction  for  acetone  (1882),  diphtheria  antitoxin 
Roux  and  von  Behring  1890-93),  the  Rontgen  rays  (1893),  H.  Quincke’s  lumbar 
puncture  (1895)  and  Gaertner’s  tonometer  (1899). 

Of  treatises  on  nervous  diseases  in  children,  perhaps  the  earliest  was  L.  W. 
Mauthner’s  Diseases  of  the  Brain  and  the  Spinal  Cord  (1844).  A number  of 
i .onographs  on  special  subjects  preceded  and  followed  this,  but  apart  from  the 
Lumelian  lectures  of  Charles  West  (1871),  perhaps  the  earliest  systematic  treatises 
;f  importance  were  those  of  C.  Pavonc  (Milan,  1892),  B.  Sachs  (1895),  B.  K.  Rach- 
r,  rd  (1905),  M.  Thiemich  and  J.  Zappert  (1910)  and  G.  Peritz  (1912). 

Of  original  descriptions  of  nervous  diseases,  those  of  cerebro-spinal  meningitis 
v Gaspard  Vieusseux  (1805),  tetany  by  John  Clarke  (1815),  S.  L.  Steinheim 
830),  and  J.  B.  K.  Dance  (1832),  softening  of  the  brain  by  Rostan  (1820), 
liomyelitis  by  M.  Underwood  (1786),  John  Badham  (1835),  Jacob  Heine  (1840) 
and  Duchenne  of  Boulogne  (1865),  with  the  subsequent  work  of  O.  Medin  (1890), 
yimon  Flexner  (1910-16),  Peabody,  Draper,  Dochez  and  the  report  ot  the  Swedish 
Medical  Institute  (1912),  the  various  forms  of  progressive  muscular  atrophy  by 
Duchenne  and  Aran  (1847-68),  Charcot  and  Joffry  (1869),  Charcot  and  Marie 
1886),  Erb  (1884-91),  Guido  Werdnig  (1890-94)  and  Johann  Hoffmann  (1894), 
ngenital  spastic  paraplegia  by  William  John  Little  (1861),  hereditary  ataxia  by 
Nikolaus  Friedreich  (1863-76),  amaurotic  family  idiocy  by  Bernard  Sachs  (1887), 

1 reditarv  cerebellar  ataxia  by  Pierre  Marie  (1893),  progressive  interstitial  hyper- 
trophic neuritis  by  Jules  Dejerine  and  Jules  Sottas  (1893)  called  erythema 
'•ifectiosum  by  Salomon  Strieker  (1899)  and  amyotonia  congenita  by  Hermann 
pepnheim  (1900)  may  be  noted. 

Among  the  many  writings  on  infantile  psychology  are  a history  of  the  develop- 
ment of  the  infant  mind  and  morale  up  to  the  fourth  month  by  R.  B.  {Jour.  Nat. 

P ilos.,  1806),  the  investigations  of  J.  E.  Lobisch  (1851),  and  Adolf  Ivussmaul 
r the  psychic  life  of  the  newborn  child  (1859),  Ritter  von  Rittershain’s  Geistes- 
en  (1871),  Charles  Darwin’s  Biography  of  an  Infant  (1877),  Wilhelm  Preyer’s 
Die  Seele  des  Kindes  (1882,  8th  ed.,  1912),  the  books  of  J.  W.  Ballantyne  (1890), 
Millicent  W.  Shinn  (1893-1907),  Biography  of  a Baby  (1900),  J.  Mark  Baldwin 
tS96),  Kathleen  C.  Moore  (1896),  Maurice  de  Fleury  (1899),  Clifford  G.  Grulee 
(1915),  Karl  Groos  on  games  (1899)  and  the  psychic  life  of  the  child  (1903), 
Albert  Moll  on  the  sexual  life  of  the  child  (1899),  the  essays  of  Sigmund  Freud  on 
ti  e same  theme,  and  the  studies  of  G.  Stanley'  Hall  (1880-1914). 

The  earlier  writers  on  the  education  of  children  were  Oribasius,  Erasmus 
1 516,  1529)  and  John  Locke. 

Other  works  relating  to  the  subject  of  child-study  are  the  anthropometric 
investigations  of  H.  P.  Bowditch  (1879-91),  W.  T.  Porter  (1892-3),  Francis 
Warner  (1888-1917),  Arthur  MacDonald  Q899),  Franz  Boas  and  others,  H.  Ploss’s 
Das  Kind  (1877),  Timothy  Dwight’s  Frozen  Sections  of  a Child  (1881),  C.  H- 
Siratz’s  album  “Die  Korper  das  Kindes’’  (1903),  the  books  of  A.  F.  Chamberlain 
(1896,  1900)  W-  M.  Feldman  on  the  Jewish  Child  (1917)  and  on  ante-natal  and 
post-natal  child  physiology  (1920),  Oscar  Chrisman’s  The  Historical  Child  (1920)n 
and  the  literature  of  pedagogics. 

Of  treatises  on  infantile  surgery  and  the  surgical  diseases  of  childhood,  aside 
fiom  two  small  publications  on  surgical  diseases  of  the  newborn  by  C.  J.  Oehme 
(1773)  and  F.  Zehler  (1830),  the  earliest  of  importance  was  that  of  John  Cooper 
Forster  (1860)  of  Guy’s  Hospital,  which  was  followed  by  those  of  P.  Guersant 
864-7),  Timothy  Holmes  (1868),  Joachim  Giraldes  (1869),  Cesare  Fumagalli 
1875),  L.  A.  de  Saint-Germain  (1884),  Edmund  Owen  (1885),  Jose  Ribeira  y 

Vol.  I — 8 


114 


HISTORY  OF  PEDIATRICS 


Sans  (1887),  Ferdinand  Karewski  (1894),  D’Arcy  Power  (1895),  Piechaud  and 
Denuce  (1900),  Sebastian  Recasens  y Girol  (1901),  Auguste  Broca  (1902.  1911, 
1914),  Samuel  W.  Kelley  (1909),  D.  G.  Gorokoff  (1910),  William  F.  Campbell  and 
L.  Kerr  (1912)  and  Louis  Ombredanne  (1912).  The  work  of  Harvey  Cushing 
(1905)  and  others  on  intracranial  surgery  in  the  newborn  deserves  mention  here. 

The  history  of  infantile  orthopedics  is  co-existent  with  the  history  of  ortho- 
pedics itself.  The  earlier  landmarks  are  the  treatise  irepi  apdpov  of  Hippocrates,  the 
use  of  redressement  force  (Calot,  1896)  by  Hippocrates  and  Avicenna,  the  Children’s 
Book  of  Felix  Wiirtz  (1598),  the  treatise  of  J.  C.  G.  Jorg  (1816),  the  writings  of 

Llnderwood,  Charles  Badham,  Rilliet 
and  Barthez  on  poliomyelitis,  the  work 
of  Jean-Andr6  Venel  at  Orbe  (1780-91), 
of  the  elder  Graefe,  Dieffenbach,  Stro- 
meyer  and  Gustav  Simon  in  plastic 
surgery  and  the  work  of  the  Heine  family. 
The  founder  of  this  famous  group  of 
surgical  mechanicians  and  orthopedists 
was  Johann  Georg  Heine  (1770-1838), 
of  Lauterbach  (Wurttemberg),  who  be- 
came surgical  instrument  maker  and 
bandagist  to  the  University  of  Wurtz- 
burg  in  1802.  Being  in  friendly  touch 
with  the  elder  Langenbeck  and  other 
prominent  German  surgeons  of  his  time, 
he  soon  learned  the  essentials  of  anatomy 
and  the  mechanical  side  of  surgery,  in- 
vented many  important  appliances, 
published  several  extensive  catalogues 
of  his  business  output,  erected  the  Caro- 
line Institute  of  Orthopedics  (1816)  and 
became  orthopedist  and  assessor  to  the 
Medical  Faculty  of  the  University.  His 
son  Joseph  von  Heine  (1803-77),  became 
a well-known  physician,  and  his  nephew 
Fig.  35.  Adolf  Lorenz  (1854-  Bernhard  Heine  (1800-46),  continued 

(Courtesy  of  Di.  J.  II.  Hess,  the  business,  invented  the  osteotome 

icago.)  (1830),  did  experimental  surgery  on  dogs, 

for  which  he  won  two  Monthvon  prizes 
(1835,  1838),  and  became  professor  of  experimental  physiology  in  the  Wurtz- 
burg  High  School.  The  other  nephew,  Jacob  von  Heine  (1880-79),  of 
Lauterbach,  graduated  in  medicine  at  Wurtzburg  (1829),  founded  on  orthopedic 
institute  at  Canstatt  (1829),  where  he  made  a great  reputation,  particularly  by  his 
classic  monograph  on  infantile  paralysis  or  poliomyelitis  (1840,  2d  ed.,  1860), 
illustrated  with  interesting  plates,  and  that  on  spontaneous  and  congenital  dis- 
locations (1842).  It  was  Heine’s  monograph  which  first  drew  modem  attention  to 
poliomyelitis.  He  died,  covered  with  honors,  on  November  12, 1879.  In  the  later 
period,  Louis  Albert  Sayre  (1820-1900),  of  New  Jersey,  introduced  jacket  suspen- 
sion in  Pott’s  disease  (1877);  Albert  Hoffa  (1859-1907),  at  Wurtzburg,  introduced 
a well-known  operation  for  congenital  dislocations  of  the  hip  joint  (1S90),  and 
Adolf  Lorenz  (1854-  ),  of  Vienna,  professor  of  surgery  in  the  University,  made 

a great  reputation  in  Europe  and  America  by  his  bloodless  method  of  reducing 
congenital  dislocations  of  the  hip-joint  by  forcible  manipulation  (1895).  The 
work  of  Robert  Jones  in  Liverpool,  of  Royal  Whitman  in  New  York,  of  Abbott, 
Bradford,  Lovett,  Osgood,  Codman,  Goldthwait  and  the  other  orthopedists  of  the 
New  England  school  belongs  to  recent  surgery. 

School  Hygiene  and  Pedagogics. — In  the  eighteenth  century,  some 
attention  was  paid  to  the  untoward  effect  of  close  mental  work  and 


THE  NINETEENTH  CENTURY 


115 


sedentary  occupations  upon  the  health  of  the  individual.  At  the 
beginning  of  the  century,  Ramazzini  published  his  treatise  on  occupa- 
tional diseases  (1700),  and  later  Tissot  (1769),  Ackermann  (1771)  and 
others  wrote  on  the  hygiene  of  literary  men.  In  1777-88,  Johan  Peter 
Frank  published  the  first  systematic  treatise  on  public  hygiene,  in  four 
volumes.  The  chapter  on  school  hygiene  shows  the  influence  of 
Rousseau.  With  the  single  exception  of  school-lunches,  every  physical 
need  of  the  school-going  child  is  considered,  and  the  sentences  upon  the 
correct  adjustment  of  light,  the  effect  of  the  height  of  benches  and  the 
slant  of  desks  upon  the  eyes  and  the  spine  of  the  pupils,  are  entirely 
modern  in  spirit.  After  the  time  of  Frank,  there  is  long  silence  in  the 
records,  until,  in  1833,*  Dr.  Edward  Reynolds,  of  Massachusetts,  filed 
a brief  for  a better  understanding  of  the  hygiene  of  young  students  by 
parents  and  teachers,  in  particular,  the  effects  of  crowded  rooms,  over- 
study at  the  expense  of  sleep,  unhygienic  posture  and  improper  diet. 
Three  years  later,  C.  J.  Lorinser  published  an  essay  on  “The  Protection 
of  Health  in  Schools”  (1836), f which  deals  almost  entirely  with  the 
crowded  courses  and  the  consequent  overtaxing  of  students  in  the  gym- 
nasia, but  emphasizes  the  danger  of  tuberculosis.  This  essay  excited 
great  interest,  was  reprinted  in  1861,  and  was  the  starting  point  of  the 
German  propagandism.  In  1842,  gymnastic  instruction  became 
obligatory  in  Prussia.  In  1862,  Max  von  Pettenkofer  published  his 
investigations  of  the  faulty  ventilation  of  schoolrooms  and  its  effects 
upon  the  pupils.  Sir  Henry  Acland  published  a report  on  the  sanitary 
conditions  of  the  Cowley  Industrial  School  in  1863.  In  1865  appeared 
the  papers  of  FahrnerJ  and  Parow§  upon  the  bad  effects  of  faultily 
constructed  school-desks.  Fahrner’s  work  soon  attracted  the  atten- 
tion of  Hermann  Cohn,  who  was,  in  a very  real  sense,  the  founder  of 
hygienic  inspection  of  school-children. 

Hermann  Ludwig  Cohn  (1838-1906),  of  Breslau,  studied  physics 
and  chemistry  under  Bunsen,  Kirchhoff  and  Helmholtz,  taking  his 
doctor’s  degree  in  philosophy  at  Breslau  (1860)  and  in  medicine  at 
Berlin  (1863),  where  he  was  a pupil  of  Graefe.  In  1866,  he  began  to 
practice  ophthalmology  at  Breslau,  where  he  opened  a private  eye- 
clinic,  and  eventually  became  professor  extraordinarius  in  the  Univer- 
sity (1873).  His  practice  gave  him  an  experience  of  some  20,000 
refraction  cases.  In  1866,  he  published  an  investigation  of  myopia 
from  defective  lighting  and  faulty  benches  in  7658  school-children. 
In  the  following  year  came  his  famous  monograph  on  the  examination 
of  the  eyes  of  10,060  school-children  for  visual  defects  from  unhygienic 
conditions  (1867).  He  found  but  little  myopia  in  the  village  schools, 
five  times  as  many  myopes  in  the  elementary  schools  of  cities,  15  times 

* Reynolds,  On  the  Importance  of  a Knowledge  of  the  Principles  of  Physiology 
to  Parents  and  Teachers,  Boston  (1833;. 

t Lorinser,  Zum  Schutz  der  Gesundheit  in  den  Schulen,  Med.  Ztg.  Berlin,  1, 
(1836),  pp.  1-4. 

t Fahrner,  “Das  Kind  und  der  Sehultisch.”  Zurich  (1865). 

§ Parow,  Ueber  die  Nothwendigkeit  einer  Reform  der  Schultische,  Berlin 
Schul.-Ztg.  (1865). 


116 


HISTORY  OF  PEDIATRICS 


as  many  in  the  Realschule  and  20  times  as  many  in  the  gymnasia.  In 
this  field,  Cohn  had  been  preceded  by  James  Ware,  who  in  1812, 
examined  the  eyes  of  1300  boy  cadets  in  the  Military  School  at  Chelsea 
(England),  by  a government  investigation  of  myopia  in  the  school- 
children  of  the  Grand-Duchy  of  Baden  ( circa  1840),  by  Szokalki’s 
investigations  of  school-children  in  Paris  (1848),  by  Jager  in  Vienna 
(1861)  and  by  Riite  in  Leipzig  (1865).  Although  Cohn  drew  from 
his  figures  the  erroneous  conclusion  that  the  degree  of  visual  defect 
is  a mathematical  function  of  the  number  of  years  of  school-life,  instead 
of  the  individual  age  as  affected  by  heredity  (Fulton)*  and  although 
the  preponderance  of  male  myopes  in  his  statistics  is  easily  explained, 
the  real  importance  of  his  research  lies  in  his  insistence  upon  the  effect 
of  bad  lighting,  faulty  desks  and  benches,  and  poorly  printed  books 
upon  the  engorgement  of  the  eye  with  blood  through  bending  and  the 
increased  intraocular  pressure  and  extension  of  the  eye  in  the  vertical 
plane  through  reading  at  close  range.  This  memoir  was  epochal  as 
awakening  the  medical  public,  and  as  being  the  starting  point  of  the 
innumerable  school-inspections  of  various  kinds  'which  have  since  been 
made.  It  led  to  the  foundation  of  the  Society  for  the  Prevention  of 
Blindness  (1880),  which  offered  a prize  of  £80  for  the  best  book  on  the 
subject  (1882),  won  by  Ernst  Fuchs  (1885). 

Cohn  meanwhile  continued  his  propagandism  along  the  broadest  lines.  In 
1867-73  he  took  up  the  hygiene  of  schoolhouses,  desks  and  benches,  in  1878  the 
investigation  of  color-blindness,  in  1880  the  printing  in  schoolbooks,  in  1882-98 
the  problem  of  medical  inspection  of  school-children,  in  1883-1902  the  lighting  of 
schoolrooms,  as  tested  by  the  Weber  photometer,  in  1894  the  color  of  window 
curtains:  in  1896,  he  made  a collective  investigation  of  infantile  conjunctivitis  in 
the  Germanic  countries,  and  in  1903-4  he  introduced  regular  inspection  of  the  eyes 
of  school  children.  In  1894,  he  published  his  paper  on  masturbation  in  children 
and  in  1904,  his  brief  for  sexual  instruction  of  the  child.  His  monograph  on  the 
hygiene  of  the  eye  in  school  children  (1883)  became  a Lehrbuch  in  1892.  Perhaps 
the  culmination  of  his  work  was  his  examination  of  the  vision  of  50,000  Breslau 
school  children  (1899),  in  which  it  was  shown  that  85  per  cent,  had  supernormal 
vision  but  with  a continual  increase  in  visual  defect  as  they  mounted  from  class  to 
class.  In  this  examination,  Cohn  used  his  own  hook-shaped  test-types,  instead  of 
letters,  which  were  more  readily  guessed  by  the  pupils.  He  lived  to  see  the  first 
Congress  of  School  Hygiene  (Nuremberg,  1904). 

Cohn  was  a man  of  jovial,  good-natured  appearance,  a true  philan- 
thropist who  cheerfully  taught  all  his  life  as  an  unpaid  extraordinarius, 
and  spent  50,000  marks  upon  the  upkeep  of  his  private  clinic,  at  which 
58,481  patients  were  treated  (1866-94),  of  whom  39,362  (67  per  cent.) 
were  charity  cases. f 

In  1869,  Rudolf  Virchow  published  his  well-known  report  on  school- 
hygiene,  t which  supported  Cohn  in  his  views  about  myopia  and  dealt 

* I am  indebted  to  Dr.  John  S.  Fulton,  Secretary  of  the  State  Board  of  Health 
of  Maryland,  for  this  information. 

f For  a spirited  account  of  Cohn’s  life  and  work,  with  a full  bibliography  of  his 
writings,  see  F.  Erismann,  Ztschr.  f.  Schulgsndhtspflg.,  Hamburg  & Leipzig,  xix 
(1906),  pp.  829-880. 

X R.  Virchow,  Ueber  gewisse  die  Gesundheit  benachtheiligende  Einfltisse  der 
Schulen,”  Berlin  (1869). 


THE  NINETEENTH  CENTURY 


117 


successively  with  the  effects  of  cerebral  congestion  (headache,  epis- 
taxis,  school  children’s  goitre),  spinal  curvature,  phthisis,  digestive 
and  sexual  disorders,  contagious  diseases,  wounds  and  injuries,  ventila- 
tion, lighting,  posture,  exercise,  mental  overwork,  corporal  punishment, 
drinking  water,  etc. 

Sir  Edwin  Chadwick  wrote  “On  Schools  as  Centres  of  Children’s 
Epidemics”  (1871),  and  the  “Sanitary  Principles  of  School  Construc- 
tion” (1871).  Baginsky  published  his  Handbook  of  School  Hygiene 
in  1879.  After  this  time,  the  subject  became  a la  mode.  At  the  fourth 
International  Congress  of  Hygiene  (Geneva,  1882),  the  question  of 
medical  inspection  of  schools  and  school-children  by  trained  physicians 
(. Schularztfrage ) was  introduced  and  was  much  debated  through  the 
next  twenty  years.  In  course  of  time,  medical  as  well  as  special 
inspection  of  the  eyes,  ears,  nose,  throat  and  teeth  became  established, 
anthropometric  and  psychophysical  measurements  were  made,  and 
the  hygiene  of  the  model  school-house,  its  furniture,  lighting  and 
appointments,  was  carefully  studied.  School-lunches,  for  children, 
inaugurated  by  Count  Rumford  at  Munich  (1792),  revived  in  the 
military  Caisse  d’ecoles  at  Paris  (1849)  and  by  Victor  Hugo  at  Guernsey 
(1866),  were  established  by  law  in  France  as  cantines  scolaires  (1882); 
while  in  Germany,  the  movement,  started  at  Munich  in  1876,  had 
extended  to  half  the  cities  in  the  empire  by  1909.  School-lunches  were 
introduced  in  England  in  1902  and  in  New  York  City  on  November  23, 
1898.  Dental  clinics  were  started  at  Strassburg  and  Darmstadt  in 

1902.  In,  1915,  there  were  120  in  Germany.  A Congress  of  School  Hyg- 
iene and  Physiological  Pedagogics  was  held  at  Paris  on  November  1-2, 

1903.  The  first  International  Congress  of  School  Hygiene  was  held  at 
Nuremberg  on  April  4-9,  1904,  the  second  at  London,  1907.  As  part 
of  school  hygiene,  the  subject  of  mentally  deficient  or  “unusual” 
children  soon  began  to  loom  large.  Feeble-minded  and  half-witted 
children  were  roughly  handled  in  the  past.  At  Dessau,  Martin  Luther 
opined  that  an  idiot  child  was  possessed  by  the  devil  and  thought 
drowning  none  too  good  for  it.  In  1801-7,  J.  E.  M.  Itard  published  his 
reports  on  the  wild  boy  of  the  forest  of  Aveyron  (le  sauvage  de  VAveyron ) 
which  was  reprinted  by  Bourneville  in  1894.  Goggenmos  founded  a 
training  school  for  cretins  at  Salzburg,  which  died  out  in  1835.  Some- 
time after,  J.  Guggenbiihl  (1816-63)  founded  a similar  institution  upon 
the  Abendberg,  near  Interlaken,  based  upon  the  idea  that  the  sunshine 
of  the  Alpine  heights  was  good  for  cretins. 

Numerous  reports  were  published,  but  an  unfavorable  investigation 
by  the  Swiss  government  (1888)  closed  Guggenbuhl’s  institution  and  he 
died  in  obscurity.  In  1837,  Edouard  Seguin  (1812-80),  of  Clamecy 
(Nievre),  a pupil  of  Itard,  began  to  treat  an  idiot  boy  of  Paris  and 
published  his  results  in  1839.  In  the  meantime,  G.-M.-A.  Ferrus  and 
Felix  Voisin  had  started  schools  for  idiots  at  Bicetre,  to  which,  in 
1842,  Seguin  was  appointed  to  carry  out  his  method.  This  method 
is  set  forth  in  Seguin’s  publications  on  the  education  of  infants 
(1843),  on  graded  images  for  the  use  of  backward  children  (1843)  and 


118 


HISTORY  OF  PEDIATRICS 


his  treatise  on  the  moral  treatment,  hygiene  and  education  of  idiots 
(1846).  In  consequence  of  the  revolution  of  1848,  Seguin  emigrated 
to  the  United  States,  where  he  wrote  the  pioneer  treatises  on  clinical 
thermometry  (1871-76)  and  continued  his  pedagogic  work  on  idiocy,  in 
which  he  was  a forerunner  of  Maria  Montessori.  Her  lectures  on  the 
education  of  backward  children  led  to  the  foundation  of  the  Scuola 
ortofrenica  at  Rome,  of  which  she  was  directress  (1898-1900).  Her 
method  is  set  forth  in  her  Anthropologia  pedagogica  (1911).  The 
education  of  the  blind  deaf-mute  Laura  Bridgman  (1829-89)  by 
Samuel  G.  Howe  (1801-76),  of  Boston,  was  another  triumph  in  peda- 
gogics. The  account  of  Laura  Bridgman  (1879)  by  Granville  Stanley 
Hall  (1846-  ),  was  the  starting  point  of  his  pioneer  work  in  child- 

study.  The  series  of  graded  tests  for  mental  retardation,  introduced 
by  Alfred  Binet  (1857-1911)  and  Theodore  Simon  in  1905-8,  are  now 
extensively  used  in  school  inspection  and  elsewhere  to  segregate 
defective  children  and  adults.  Stanley  Hall’s  Adolescence  (1904)  and 
Aspects  of  Child-life  and  Education  (1907),  E.  Claparede’s  Child 
Psychology  (1909),  Pastor  K.  Id.  G.  Witte’s  Education  of  Karl  Witte 
(1914),  George  W.  Jacoby’s  Child  Training  (1914)  Dr.  Helen  Mac- 
Murchy  on  the  Organization  and  Management  of  Auxiliary  Classes 
(Toronto,  1915)  and  Lewis  M.  Terman  on  the  Intelligence  of  School 
Children  (1919)  may  be  mentioned.  For  the  huge  literature  of  child 
study  and  pedagogics,  the  reader  must  be  referred  to  the  biblio- 
graphies of  Stanley  Hall  (1886),  Arthur  MacDonald  (1899),  W.  H. 
Burnham  (1914),  J.  T.  MacManis  (1916)  and  others. 

Children’s  Hospitals. — The  early  history  of  children’s  hospitals 
goes  back  to  the  transition  from  the  private,  personal,  egotistical 
charity  of  the  Romans  (enslavement  of  foundlings)  to  corporate  charity 
under  the  influence  of  Christianity.  This  became  dynastic  under 
Constantine  the  Great  (322  A.D.),  patriarchal  and  clerical  under 
Justinian  (533),  institutional  with  Guy  of  Montpellier  (1180),  corporate 
and  non-clerical  with  the  silk-makers  of  Florence  (1211),  state- 
institutional  under  Louis  XIV  (1670)  and  philanthropic  and  national 
in  France  and  Russia  at  the  end  of  the  18th  century  (Hugel).* 

Archbishop  Datheus  founded  the  first  authentic  foundling  asylum  in  787  at 
Milan.  This  was  followed  by  similar  institutions  at  Bergamo  (982),  Laibach 
(1041),  Padua  (1097),  Florence  (Spedale  di  S.  Maria  della  Scala,  11(31),  and 
the  hospital  founded  by  Guy  and  his  Order  of  the  Holy  Ghost  (1144)  at  Mont- 
pellier (1180).  A bull  of  Innocent  III  states  that  this  order  had  created  nine 
foundling  asylums  in  1198.  Another  bull  of  the  same  Pope  lists  29  foundling 
asylums  in  France  under  Philip  IV  (The  Fair).  Other  asylums  were  founded  at 
Arezzo  (1188)  and  Florence  (1193),  and  in  1198,  Innocent  III  provided  the  Con- 
servatorio  della  Ruota,  in  the  Ospedale  dello  Santo  Spirito  in  Rome,  with  accommo- 
dations for  600  foundlings,  and  a rotary  contrivance  (ru-ota)  for  receiving  them  at 
the  door  In  the  thirteenth  century,  asylums  were  founded  at  Parma  (1201), 
Aix,  Toulon,  Novarra  and  Volterana  (1201),  Prato  and  Jerusalem  (1210),  Florence 

* Hugel,  F.  S.,  Beschreibung  sammtlicher  Kinderheilanstalten  in  Europa, 
Vienna  (1849),  which  contains  a full  account  of  children’s  hospitals  in  Europe  up  to 
the  date  of  its  publication.  For  the  history  of  foundling  asylums,  see  his  ‘‘Die 
Findelhauser  und  das  Findelwesen  Europa’s."  Vienna  (1863). 


THE  NINETEENTH  CENTURY 


119 


(1218),  Bellinzona  {circa,  1250),  Gimignano  (1258),  Lucca  (1268),  Embeck  (1274), 
Cortona  (1286)  and  Tauris  (1294).  In  the  fourteenth  century,  the  Hopital  de 
l'Esprit  Sainte  was  founded  at  Paris  (1362),  first  for  the  reception  of  foundlings, 
later  for  legitimate  children  only  (1422).  This  had  been  predeced  by  an  institution 
of  similar  name,  founded  by  Enrad  Heinz  at  Nuremberg  (1331),  and  was  followed 
by  another  at  Venice  (1380).  On  October  25,  1421,  the  famous  Ospedale  degl’ 
Innocenti  was  founded  at  Florence,  in  1426,  the  Pio  Istituto  degl’  Esposti  at 
Verona,  and  others  at  Genoa  (1420),  Bergamo  (1438),  Brescia  (1447),  Mantua 
(1449),  Cremona  (1450),  Lodi  (1458),  Como  (1468),  Cremona  (1479),  and  Munich 
(1489).  In  the  sixteenth  century,  foundling  and  orphan  asylums  were  erected  at 
Locarno  (1501),  Reggio  (1513),  Naples  (1515),  Pistoja  (1539),  Paris  (Hopital  de  la 
Trinitd,  1545),  London  (Christ’s  Hospital  School,  1553),  Piacenza  (1573)  and 
Amsterdam  (1594). 

It  is  not  probable  that  any  of  the  early  medieval  establishments 
were  true  hospitals  (in  the  sense  of  being  places  where  disease  was 
actually  treated)  but  merely  places  of  refuge  and  shelter.  It  was  only  at 
the  end  of  the  fifteenth  century,  as  Sudhoff  has  shown,  when  physicians 
began  to  give  the  inunction,  sweating  and  guaiac  treatment  of  syphilis 
in  hospital,  that  the  hospitals  for  “ curabiles,  ergo  curandi”  began 
to  spring  up  alongside  of  hospitals  set  apart  for  incurable  cases  and 
isolation  hospitals  for  lepers  and  epileptics.* 

In  1639,  St.  Vincent  de  Paul  (1576-1660),  who  had  a worthy  precursor  in  St. 
Thomas  of  Villanueva  (1488-1555),  moved  the  asylum  founded  bv  an  unknown 
widow  in  the  rue  St.  Landry,  Paris  (“La  Couche,”  1638)  to  the  Faubourg  St. 
Victor,  to  become  the  Hospice  de s enfans  trouves  (1640)  which  was  declared  a 
public  institution  by  Louis  XIV,  in  June,  1670.  Other  foundling  and  orphan 
asylums  existed  at  Hamburg  (1604),  Dresden  (1618),  Toledo  (1629),  Wurtzburg 
(1639),  Peking  (1662),  Mainz  (1665),  Erfurt  (1664,  1669),  Brunswick  (1677), 
Frankfurt  (1679),  Bremen  (1692)  and  Berlin  (1697);  and  in  the  eighteenth  century 
at  Prague  (1704),  Novgorod  (1708),  Hamburg  (1709),  Edinburgh  (1732),  Rio  de 
Janeiro  (1738),  London  (1739),  Vienna  (1742),  Turin  (1748),  Strassburg  (1748), 
Copenhagen  (1753),  Stockholm  (1753),  Moscow  (1762),  Petrograd  (1770),  Dublin 
(1781)  and  London  (1789). 

The  first-  dispensary  for  children  in  Europe  was  that  started  by  Dr.  George 
Armstrong  in  London  (1769-81).  This  was  followed  by  the  institution  founded  by 
Johann  Joseph  Mastalier  in  Vienna  (1787),  which  was  continued  after  his  death  by 
Leopold  Anton  Golis  (1794)  and  still  exists.  The  Royal  Sea-bathing  Infirmary 
and  National  Hospital  for  Scrofula  was  founded  at  Margate,  England  in  1796. 
In  1785,  at  the  instance  of  Louis  XVI,  a commission  of  the  Academie  des  Sciences 
(Bailly,  Laplace,  Lavoisier,  et  al.)  prepared  a report  on  the  wretched  accommoda- 
tions, appointments  and  hygienic  status  of  the  Hotel  Dieu,  in  which  eight  to  nine 
children  were  found  lying  in  one  bed,  with  an  almost  total  mortality.  In  1788,  J.  R. 
Tenon  made  his  famous  report  and  recommendations  for  reforms  in  hospital  con- 
struction and  hygiene.  As  aresult,  the  foundling  asylum  known  as  the  “ Maison  de 
l’Enfant  Jesus”  (1751)  was  transformedinto  the  present  Hopital  des  enfans  malades 
(1802).  This  was  for  a long  time,  the  largest  children’s  hospital  in  Europe,  f A 
children’s  dispensary  was  founded  at  Briinn  by  Dr.  Ringolini  (1810),  Armstrong’s 
London  Dispensary  was  revived  by  John  Bunnell  Davis  (1816)  and  followed  by  a 
hospital  at  Vienna  (1826).  The  Nicholas  Children’s  Hospital  was  founded  at  Petro- 
grad by  Dr.  Friedeberg  in  1834,  the  pediatric  clinic  in  the  Charite  at  Berlin  in 
1834.  Others  followed  at  Dresden  (1834),  Vienna  (L.  Mauthner,  1837),  Budapest 

* Pagel-Sudhoff,  “Einfiihrung  in  die  Geschichte  der  Medizing  2.  Aufl.”  Berlin, 
(1915),  p.  188. 

fFor  the  history  of  the  Hopital  des  enfants  malades  (1802-1913),  see  P. 
Lereboullet,  Paris  mdd.,  xiv  (1913-14),  suppl.,  pp.  3-19. 


120 


HISTORY  OF  PEDIATRICS 


(1839),  Hamburg  (1840),  Stuttgart  (1842),  Prague  (Kaiser  Franz  Joseph,  1842), 
Vienna  (St.  Joseph’s,  1842),  Moscow  (1842),  Frankfurt  (1843),  Turin  (1843), 
Berlin  (Elizabeth  Hospital,  1843),  Graz  (1844),  Berlin  (Louisa  Hospital,  1844), 
Lemberg  (by  regimental  surgeon  Brum,  1845),  Stockholm  (Pediatric  Clinic,  1845), 
Turin  (Ospedaletto  di  Santa  Filomena,  1845),  Copenhagen  (Bomehospital  by 
J.  L.  Dreyer,  1846),  Munich  (1846),  Constantinople  (1847). 

Children’s  hospitals  in  England  and  America  date  from  the  middle 
of  the  nineteenth  century.  About  1849,  Dr.  Charles  West,  of  London, 
attempted  to  convert  the  Royal  Infirmary  for  Sick  Children  in  Water- 
loo Bridge  Road  (1816)  from  a scattered  set  of  dispensaries  into  a true 
hospital  for  sick  children,  but  was  frustrated  by  the  professional  jeal- 
ousy of  his  colleagues.  In  spite  of  these  rebuffs,  he  visited  all  the 
London  hospitals,  wrote  to  all  the  continental  children’s  hospitals  for 
data,  and  through  the  social  prestige  of  Bence  Jones,  he  at  length 
secured  a footing  and  a fund  for  his  project.  After  much  opposition 
and  many  disappointments,  after  West  had  travelled  over  France 
and  Germany  for  further  information,  the  Hospital  for  Sick  Children 
in  Great  Ormond  Street  was  opened  (February,  1852),  in  a house  which 
had  once  been  occupied  by  the  celebrated  Dr.  Richard  Mead.  Mead’s 
drawing  room,  with  its  painted  shepherds  and  shepherdesses,  became 
the  girl’s  ward,  and  his  museum  the  out-patient  department.  Dr. 
West  and  his  wife  did  all  the  furnishing.  West  himself  organized  the 
system  of  accounting,  the  diet  table,  the  Samaritan  Fund,  the  system 
of  boarding  out  in  cottages,  the  Museum  of  Anatomy,  drew  up  the 
catalogue,  acted  as  physician-in-chief  and  later  started  an  infant 
nursery  or  creche  and  a convalescent  branch  in  Cromwell  Street. 
The  hospital  thus  accommodated  75  patients  and  52  convalescent 
patients.  During  1852,  it  took  in  143  patients  and  1250  out-patients, 
during  1871,  998  patients,  and  11,988  out-patients,  during  1852-71, 
10,442  patients  and  200,  691  out-patients.  Dr.  West  resigned  in  1875, 
and  did  not  apply  for  his  position  again,  but  when  the  hospital  was 
rebuilt  (in  1875),  he  furnished  it  again  throughout  and  gave  it  his  library 
and  pathological  drawings.*  A brilliant  account  of  the  Hospital  was 
written  by  Charles  Dickens  in  1852.  Dicken’s  speech  of  February  9, 
1858,  in  behalf  of  this  institution  is  one  of  the  finest  specimens  of  his 
genius.  Miss  Mulock,  Tom  Hood  and  others  also  lent  their  pens  to  its 
aid.  The  hospital  was  further  enlarged  in  1892,  1899  and  1908,  and 
now  has  240  beds,  a Private  nursing  institution,  a medical  school  in 
affiliation  with  London  University,  at  which  Garrod,  Still,  Poynton  and 
Hutchinson  are  teachers,  a casualty  department  and  the  largest  out- 
patient service  in  the  world. 

The  other  children’s  hospitals  of  London  are  the  Kensington  Dispensary  (1S40, 
rebuilt  1901),  The  Belgrave  (1863,  1903),  Grosvenor  (1866),  Victoria,  Chelsea 
(1866),  Northeastern  (Queen’s),  Bethnal  Green  (1867),  Alexandra  (Hip  Disease, 
1867,  1894),  East  London  (1868),  Evelina  (1869),  Sydenham  Road  (1872),  Cheyne, 
Chelsea  (1874),  St.  Monica’s  Home  (1874),  Paddington  Green  (18S3,  1S95,  1911), 
St.  Mary’s  Plaistow  (1893),  Infant’s  Hospital,  Vincent  Square  (1903,  1907), 
Woolwich  (1905),  Queen  Mary’s  (1907)  and  Park  Hospital,  Lewisham  (1910). 
The  largest  of  these  are  the  East  London  and  the  Evelina.  The  Provincial  chil- 
* Brit.  Med.  Jour.,  London,  i (1898),  p.  922. 


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121 


dren’s  hospitals  of  England  are:  Kidderminster  (1821,  1870),  Manchester  (1829, 
1903,  1907,  1912),  Liverpool  Infirmary  (1851,  1868),  Leeds  (1853),  Jenny  Lind 
Infirmary,  Norwich  (1853),  Manchester  (1855),  Bristol  (1857,  1885),  Newcastle 
(1861,  1888),  Sunderland  (1864),  Gloucester  (1867),  Brighton  (1868),  Nottingham 
(1869),  Birkenhead  and  Wirral  (1869),  Hull  (1872),  Sevenoaks  (1872),  Cheltenham 
(1874,  1901),  Sheffield  (1876,  1896,  1902,  1906),  Derbyshire  (1877),  Bradford 
(1883),  Newbury  (1886),  Gateshead  (1887)  Rosehill  (Babbicome,  1888,  Torquay, 
1902),  Heswall,  Cheshire  (1899,  1908). 

In  Scotland:  the  Royal  Edinburgh  (1859,  1895),  Royal  Aberdeen  (1897), 
Edinburgh  (1878,  1885),  and  Royal  Glasgow  (1883).  In  Ireland,  the  National, 
at  Dublin  (1821),  the  Dublin  Children’s  Hospital  (1872,  1874),  Ulster,  Belfast 
(1872,  1911-12),  Belfast  (1873,  1885)  and  Victoria,  Cork  (1874).  In  Canada: 
Toronto  (1875).  In  India:  Bombay  (1876).  In  Australia,  those  at  Melbourne 
(1870),  Adelaide  (1876; , Brisbane  (1877),  Rockhampton,  Queensland  (1885)  and 
Perth,  West  Australia  (1909). 

Among  the  many  children’s  hospitals  founded  on  the  continent  of  Europe  after 
1850  are  those  at  Stettin  (1851),  Paris  (Sainte  Eug6nie,  1854),  Stockholm  (Crown 
Princess  Louisa,  1854),  Wildbad-Ludwigsburg  (1854),  Leipzig  (C.  Hennig’s  Poly- 
clinic, 1855),  Petrograd  (1855),  Basel  (1862),  Berne  (Jenner,  1862),  Amsterdam 
(Emma.,  1865),  Zurich  (1868)  Petrograd  (Prince  Peter  Oldenburg,  1869),  Havre 
(1875),  Vienna  (Kronprinz  Rudolf,  1875),  Cracow  (St.  Ludwig’s,  1876),  Dresden 
(1878),  Helsingfors  (1879),  Vienna  (Carolina,  1880),  Cremona  (1881),  Naples  (Lina, 
1881),  Madrid  (Infant  Jesus,  1882),  Oporto  (Maria  Pia,  1883),  Moscow  (St.  Olga, 
1887),  Berlin  (Kaiser  und  Kaiserin  Friedrich  (1890),  Genoa,  1890),  Leipzig  (1893), 
Durkheim  (1894),  Constantinople  (Hamidie,  1898),  Athens  (St.  Sophia,  1900), 
Nancy  (J.  B.  Thierry,  Maxesville,  1900),  Paris  (Bretonneau,  1900,  Trousseau,  1900, 
Pasteur,  1900),  Paris  (H4rold,  1901),  Parma  (1901),  Paris  (Polyclinique  H.  de  Roths- 
child, 1902),  Berlin,  University  Clinic,  Charte  1903,  Bordeaux  (suburban  hospital 
at  Bouscat,  1903),  Cremona  (1904),  Rostock  (Clinic,  1905),  Lodz  (1906),  Budapest 
(1907),  Frankfurt  am  Main  (Annie  Stiftung,  1908),  Lublin  (1911),  Vienna  (New 
University  Hospital,  1911),  Venice  (Umberto,  1912)  and  Warsaw  (1912). 

In  1852,  one  “Philopedos,”  an  ex-dispensary  physician  of  New 
York  City  published  “A  Few  Remarks  about  Sick  Children,  and  the 
Necessity  of  a Hospital  for  them.”  Like  the  hero  of  the  old  Spanish 
play,  Philopedos  remained  un  hombre  sin  nombre*  but  this  particular 
hombre,  through  his  insistence  upon  the  high  mortality  of  infants  from 
ill-ventilated,  unsanitary  habitations  and  the  crowded  condition  of  the 
general  hospitals,  was  instrumental,  as  Adams  says  “in  establishing 
the  Child’s  Hospital  and  Nursery — the  first  hospital  devoted  to 
children  on  this  continent — which  was  organized  March  1,  1854,  and 
stands  to-day  as  a monument  to  this  unknown  writer.  ”f  This  hospital 
was  also  a maternity  at  the  start.  The  first  institution  designed 
exclusively  for  children  was  the  Children’s  Hospital  of  Philadelphia, 
established  in  the  following  year  (1855). 

Among  the  later  American  children’s  hospitals  are  those  at  Chicago  (Mary 
Thompson,  1865),  Boston  (1869,  rebuilt,  1914),  New  York  Foundling  (1869), 
New  York  (St.  Mary’s  1870),  New  York  Free  Dispensary  (1871),  Washington, 
D.  C.  (1871),  Radnor,  Pa.  (1873),  Atlantic  City  (1873),  Albany  (1875),  Lawrence, 
Mass.  (1875),  San  Francisco  (1875),  Philadelphia  (St.  Christopher’s,  1876), 
Philadelphia  (Children’s  Homoeopathic,  1877),  St.  Louis  (1879,  rebuilt,  1914), 
Boston  (Infant’s,  1881),  Cincinnati  (1883),  St.  Louis  (Martha  Parson’s  Free,  1884), 
Chicago  (Children’s  Memorial,  1884),  Baltimore  (Thomas  Wilson  Sanitarium, 

* Tirso  de  Molina,  El  Burlador  de  Sevilla,  act  I,  sc.  I. 

t Adams,  S.  S.,  Tr.  Am.  Pediat.  Soc.,  N.  Y.,  ix  (1897),  p.  23. 


122 


HISTORY  OF  PEDIATRICS 


1884),  New  York  (Laura  Franklin,  1886),  San  Francisco  (1886),  Detroit  (1887, 
1896),  New  York  (Babies,’  1887),  Syracuse  (1887),  Buffalo  (1892),  Columbus, 
Ohio  (1892),  Milwaukee  (1892)  and  Los  Angeles  (1913).  The  Baby’s  Hospital  of 
Philadelphia  (1921)  is  a social  service  center,  combining  a small  pediatric  ward 
with  a research  institute,  a new  departure  in  the  matter  of  raking  pediatric  service 
to  the  people.  The  many  seaside  hospitals  and  stations  for  tuberculous  children 
can  only  be  referred  to.  There  are  no  less  than  18  on  the  Italian  coast  alone. 

Clinical  instruction  in  pediatrics  was  first  introduced  by  Rosenstein 
in  Sweden  (Jacobi).  In  1761,  the  chief  physician  of  the  Lying-in 
Hospital  of  Stockholm  was  ordered,  by  royal  mandate,  to  lecture  on 
infantile  diseases  (Medin).  During  the  nineteenth  century,  pediatric 
teaching  was  for  a long  time  exploited  by  means  of  lectures,  in  which,  of 
course,  such  men  as  Trousseau,  Roger,  Bouchut  and  Parrot  in  Paris, 
Charles  West  in  London,  the  Viennese  clinicians  (Mayr,  Widerhofer, 
Escherich),  and  in  Berlin,  Henoch  and  Gerhardt  were  most  effective 
teachers.  On  April  2,  1845,  T.  T.  Berg  was  appointed  professor  of 
pediatrics  in  the  Karolin  Medico- Chirurgical  Institute  and  on  May  2, 
1845,  a pediatric  clinic  was  opened  at  the  Central  Home  for  Children. 
In  America,  Jacobi  introduced  bedside  teaching  in  his  earliest  courses 
(1862-64).  This  was  revived  in  1898,  when  Jacobi’s  pupil,  Francis 
Huber,  supplied  the  funds  for  a special  service  of  bedside  teaching  at 
the  Roosevelt  Hospital  for  the  benefit  of  the  pupils  of  the  College  of 
Physicians  and  Surgeons.  In  1910,  Mrs.  A.  Woerishoffer  donated 
$100,000  for  the  foundation  of  the  Jacobi  Division  of  the  German 
Hospital,  in  charge  of  Dr.  A.  L.  Goodman.  This,  Jacobi  characterizes 
as  the  third  phase  of  bedside  teaching  in  pediatrics.  In  the  Paris 
Faculty,  says  Hutinel,  “Roger  (1853)  taught  as  a clinician,  Parrot 
(1878)  as  an  anatomist,  Grancher  (1885)  as  a hygienist.”  During 
Parrot’s  incumbency  at  the  Hopital  des  enfants  assistes,  the  cradles 
of  the  nursling  patients  were  jumbled  closely  together,  without  regard 
to  possibilities  of  infection,  the  same  half-wiped  spoon  served  to  exam- 
ine all  throats,  the  same  thermometer,  barely  wiped  upon  an  apron, 
served  for  all  rectal  temperatures,  the  bed-linen  was  never  disinfected, 
the  mattresses  were  soiled  with  dejecta,  the  milk,  in  open  crocks, 
absorbed  all  dust  at  sweeping,  and  the  crying  infant  was  quieted  by  a 
piece  of  crumbled  biscuit  knotted  in  a rag,  dipped  into  a jar  containing 
a gummy  syrup.  The  aphthae,  vomiting,  diarrhea  and  fever  which 
resulted  from  this  regime  were  dubbed  by  Parrot  “athrepsia.”  With 
the  advent  of  Grancher  (1885),  a new  order  of  things  obtained.  Forks, 
spoons,  goblets  and  other  utensils  were  sterilized,  bed-linen  and  floors 
were  disinfected,  the  personnel  were  required  to  keep  themselves 
clean  and  not  approach  an  infectious  case  without  donning  a surgical 
blouse  beforehand.*  Much  was  learned  about  the  management  of 
infectious  cases  from  Grancher’s  wire  cages  about  the  beds  (1889), 
which  were  displaced  by  the  system  of  glass  boxing  ( boxes  vitres ) of 
Hutinel  (1894),  a system  frequently  copied,  especially  in  von  Pirquet's 

* Hutinel,  L’enseignement  de  la  pediatrie  a la  Faculte  de  Paris.  Ann.  de  mdd. 
et  chir.  infant.,  Paris,  xii  (1908),  pp.  37-50. 


THE  NINETEENTH  CENTURY 


123 


clinic  in  the  New  University  Children’s  Hospital  at  Vienna.  The 
leading  Parisian  clinics  are  those  of  Hutinel  at  the  Hopital  des  enfants 
malades,  Variot  at  the  Hopital  des  enfants  assistes  and  Netter  at  the 
Hopital  Trousseau.  In  London,  Still’s  great  outdoor  service  at  the 
Great  Ormond  Street  Hospital  is  the  largest  in  existence.  More  than 
3000  in-patients  and  as  many  as  100,000  out-patients  are  sometimes 
treated  annually.  ■ Sir  Robert  Jones’s  clinic  at  Liverpool  is  a great 
centre  for  infantile  orthopedics.  In  Leipzig,  Heubner  had,  at  the 
start,  only  a district  polyclinic,  but  through  his  exertions,  a new 
Children’s  Hospital  (1893),  with  clinic  was  acquired.  Although  the 
French,  Swiss  and  Austrian  medical  faculties  are  all  provided  with 
pediatric  clinics,  only  ten  of  the  twenty  German  universities  were  so 
provided  in  1910,  and,  in  only  eleven  was  instruction  given  by  a profes- 
sional pediatrist.*  At  Berlin,  the  science  of  infant  nutrition,  as  taught 
by  Finkelstein  and  Meyer,  is  the  feature  of  pediatric  instruction.  At 
Munich,  Pfaundler’s  clinic  is  one  of  the  best  ever  organized.  He  has 
claimed  that  he  has  more  assistants  than  patients.  This  clinic  is 
eminently  modern  in  intention,  devoted  mainly  to  prophylaxis  and 
infant  welfare.  At  the  Milk  Station,  modified  milk  and  tea  are  given 
out  freely  to  the  poor.  Bottles  are  sterilized  by  means  of  a gigantic 
wheel  arrangement.  The  Normal  Infant  Clinic  is  designed,  like  that 
of  Toronto,  to  keep  the  infant  in  sound  health  from  day  to  day.  In 
the  United  States,  very  superior  instruction  has  been  given  by  such 
able  organizers  as  Rotch  and  Morse  (Boston),  Jacobi,  Holt,  and  Chapin 
(New  York)  Howland  (Baltimore),  Abt  (Chicago),  Lucas  (San  Fran- 
cisco), Sedgwick  (Minneapolis),  Hoobler  (Detroit),  Cowie  (Ann 
Arbor),  Veeder  (St.  Louis),  and  by  such  men  as  Northup  in  the  Presby- 
terian Hospital  and  Koplik  in  Mount  Sinai  Hospital  (New  York). 

Pediatric  Societies  and  Periodicals. — In  1860,  the  New  York  Academy  of 
Medicine  attempted  to  form  a section  for  Diseases  of  Children,  but  after  a few 
tentative  meetings  the  project  was  abandoned,  and  not  until  1887  was  the  present 
Pediatric  Section  organized,  with  J.  Lewis  Smith  as  chairman.  Meanwhile,  the 
American  Medical  Association  organized  a special  Pediatric  Section  in  1880,  with 
Dr.  A.  Jacobi  as  its  first  chairman,  and  this  has  continued  to  date.  The  British 
Medical  Association  has  a similar  arrangement,  but  the  meetings  of  the  section  have 
not  been  annual  but  occasional.  In  1883,  the  Gesellschaft  der  Naturforscher 
und  Aerzte  established  a pediatric  section,  meeting  annually.  In  the  same 
year,  the  Gesellschaft  der  Kinderheilkunde  was  founded  (September  18,  1883) 
by  Gerhardt,  Henoch,  Demme,  Steffen,  Soltmann  and  others,  holding  its  first 
meeting  at  Freiburg.  The  first  presidents  were  Steffen  (1883-1900),  Heubner 
(1900-1906)  and  Escherich  (1906).  The  transactions  ( V erhandlungen , 1883-1913) 
are  of  a high  order  of  merit.  A Milk  Commission  of  the  Society  was  formed  by 
Soltmann,  Biedert,  Heubner  and  Escherich  in  1897.  Russian  pediatric  societies 
were  founded  at  Moscow  (1885)  and  Petrograd  (1892),  and  publish  transactions. 
The  American  Pediatric  Society  was  organized  in  1888,  with  Dr.  A.  Jacobi  as  its 
first  president,  his  successors  in  office  being  J.  Lewis  Smith,  Rotch  and  Osier. 
This  society  is  an  exclusive  organization  of  the  type  described  by  Weir  Mitchell: 
“a  meeting  of  men  whose  power  to  teach  others  is  a pledge  to  that  humility  which  is 
ever  seeking  to  learn.  It  has  no  medical  politics,  nor  is  it  embarrassed  by  useless 
idlers  who  look  upon  such  gatherings  as  merely  pleasant  social  meetings.”!  Its 

* Feer,  E.,  Arch.  f.  Kinderheilk.,  Stuttgart,  lii  (19'09-10),  pp.  244-259. 

t Mitchell,  Tr.  Cong.  Am.  Phys.  & Surg.,  ii  (1892),  p.  159. 


124 


HISTORY  OF  PEDIATRICS 


membership  is  limited  to  75  and  confined  to  the  serious  workers  of  scientific  type. 
The  Transactions  (1888-1921)  contain  the  best  kind  of  pediatric  literature. 
Several  local  American  pediatric  societies  have  been  formed,  notably  the  Ohio 
State  Pediatric  Society  (1895),  the  Bethesda  Pediatric  Society  of  St.  Louis  (1895), 
the  Philadelphia  Pediatric  Society  (1896),  the  Indiana  State  Pediatric  Society 
(1897),  the  Chicago  Pediatric  Society,  the  Central  States  Pediatric  Society,  and 
the  New  England  Pediatric  Society.  There  is  also  the  National  Association  for 
the  Study  and  Education  of  Exceptional  Children  (1905),  the  Association  of  Ameri- 
can Teachers  of  Diseases  of  Children  (1907),  the  American  School  Hygiene  Associa- 
tion (1907),  the  American  Association  of  Medical  Milk  Commissions  (1907)  and  the 
American  Association  for  the  Study  and  Prevention  of  Infant  Mortality  (1909). 
which  became  the  American  Child  Hygiene  Association  in  1919.  The  Society 
for  the  Study  of  Diseases  of  Children,  established  at  London  in  1900,  has,  since 
November  27,  1908,  been  merged  into  the  Section  for  the  Study  of  Diseases  of 
Children  of  the  Royal  Society  of  Medicine  (Reports  of  Society,  1900-1908,  Proceed- 
ings of  Section,  1908-21).  The  Societe  de  pediatrie  of  Paris  was  established  in 
1899,  and  has  published  Bulletins  to  date.  A French  Congress  of  gynecology, 
obstetrics  and  pediatrics  was  held  at  Bordeaux  in  1895  and  published  Memoires 
for  several  years.  An  Italian  pediatric  congress  (Congresso  pediatrico  italiano) 
was  organized  in  1890  and  published  Atti  for  a number  of  years.  Every 
International  Medical  Congress  (1867-1913)  has  had  a pediatric  section.  An 
International  Congress  of  Pediatrics  was  held  at  Paris  on  October  7-9,  1912,  and 
has  published  its  Comptes-rendus  (Paris,  1913). 

The  first  International  Congress  of  School  Hygiene  was  held  at  Nuremberg 
in  1904.  An  International  Milk  Federation  ( Federation  international 'c  de  la 
laiterie ) has  held  Congresses  at  Brussels  (1903),  Paris  (1905),  The  Hague  (1907), 
Budapest  (1909)  and  Stockholm  (1911).  A Union  Internationale  pour  la  protec- 
tion de  I’enfance  du  premier  age,  has  for  its  function  the  organization  of  Congresses 
of  Milk  Stations,  has  held  one  Congress  at  Budapest  (1905)  and  is  the  parent  of 
International  Congresses  for  the  Study  and  Prevention  of  Infant  Mortality  held 
at  Paris  (1905),  Brussels  (1907)  and  Berlin  (1911). 

According  to  Crozer  Griffith,  * the  earliest  periodical  to  be  concerned  with  pediat- 
rics was  the  Archiv  fur  die  Geburtshilfe,  Frauenzimmer-  und  neu-gebohrner  Kinder- 
krankheiten,  started  at  Jena  in  1787.  The  first  periodical  devoted  exclusively  to 
pediatrics  was  the  Analekten  iiber  Kinderkrankheiten  (Stuttgart,  1834—37).  A 
Clinique  des  maladies  des  enfants  of  the  Strassburg  Faculty  for  1837-41  was  edited 
by  V.  Stober  in  1841.  La  Clinique  des  hopitaux  des  enfans,  with  Yanier  as  editor, 
was  published  at  Paris  in  1841-44.  The  Children’s  Hospital  at  Dresden  published 
a Jahrbuch  for  the  year  1844-45.  The  J ahrbuch  fur  Kinderheilkunde  was  started  at 
Vienna  in  1857,  with  F.  Mayr  as  editor  and  has  been  continuous  to  date.  The 
Archiv  fur  Kinderheilkunde  (1870),  the  Kinder- Arzt  (1890)  and  the  Centralblatt  fur 
Kinderheilkunde  (1896)  followed.  The  Revue  mensuelle  des  maladies  de  I’enfance 
(1883),  and  the  Archives  de  medicine  des  enfants  (1898)  are  prominent  in  France. 
The  Archives  of  Pediatrics  was  started  in  New  York  by  William  Perry  Watson  in 
1884,  and  Pediatrics  by  George  Carpenter  in  1895.  La  Pediatria  was  started  at 
Naples  by  Francesco  Fede  in  1893.  The  monthly  Dietskaya  meditsina  (Moscow, 
1896-1903)  was  in  its  time  the  principal  Russian  periodical. 

The  British  Journal  of  Children’s  Diseases  was  established  in  London  by 
George  Carpenter  in  1904.  The  American  Journal  of  Diseases  of  Children,  the 
best  pediatric  periodical  in  English  was  started  in  1911. 

A list  of  pediatric  journals  and  transactions,  arranged  in  chronological  order 
is  subjoined: 

* Crozer  Griffith,  J.,  P.  “Jour.  Am.  Med.  Assoc.”  Chicago  XXI  (1S9S) 
pp.  947-951. 


PERIODICALS  AND  TRANSACTIONS  DEVOTED  TO  PEDIATRICS  125 


PERIODICALS  AND  TRANSACTIONS  DEVOTED  TO  PEDIATRICS 

EXCLUSIVELY 

Bibliothek  fur  Ivinderarzte.  v.  1.  8°.  Vienna  (1792). 

Analekten  uber  Kinderkrankheiten.  ed.  Riecke.  Hfte.  1-12.  4 v.  8°.  Stutt- 

gart (1834-37). 

Clinique  (La)  des  hopitaux  des  enfants.  ed.  Paul  Prosper  Vanier.  v.  1—4.  8°. 

Paris  (1841-44). 

Journal  fur  Kinderkrankheiten.  ed.  Barthez,  Berg  [ et  al.]  v.  1-59.  8°.  Berlin 

(1843-7);  Erlangen  (1848-72). 

Oesterreichische  Zeitschrift  ftir  Kinderheilkunde.  ed.  B.  Kraus  and  L.  Mauthner. 
v.  1-2.  8°.  Vienna  (1855-57). 

Jahrbuch  fur  Kinderheilkunde  und  physische  Erziehung.  ed.  Fr.  Mayr.  v.  1-8. 
8°.  Vienna  (1857-66);  n.F.  ed.  Prof.  Binz  [et  al.].  v.  1-97.  Vienna 
(1867-1922). 

Jahrbuch  ftir  Phvsiologie  und  Pathologie  des  ersten  Kindesalters.  ed.  Ritter 
von  Rittershain.  v.  1.  8°.  Prague  (1868). 

Oesterreichisches  Jahrbuch  ftir  Paediatrik.  ed.  Ritter  von  Rittershain  and  Maxi- 
milian Herz.  v.  1-8.  8°.  Vienna  (1870-77). 

Central-Zeitung  ftir  Ivinderheilkunde.  ed.  Adolf  Baginsky  and  Alois  Monti,  v. 
1-2.  40.  Berlin  (1877-79). 

Archiv  ftir  Kinderheilkunde.  Founded  by  Adolf  Baginsky,  M.  Herz,  A.  Monti 
(1880-92);  ed.  Baginsky,  Monti  and  A.  Schlossmann  1892-1922.  v.  1-71. 
8°.  Stuttgart  (1880-19221).  Current. 

Gesellschaft  ftir  Ivinderheilkunde.  Verhandlungen.  v.  1-30.  8°.  (1883-1913). 

Revista  de  enfermedades  de  ninos.  Redactada  por  el  cuerpo  facultativo  del 
Hospital  del  Nino  Jesus,  v.  1.  8°.  Madrid  (1883). 

Archivio  di  patologia  infantile,  ed.  Luigi  Somma.  v.  1-6.  8°.  Naples  (1883-88)  . 
Bulletinhygieniqueetstatistiquedesenfantsduleragedelavilled’Alger.  . . ed. 

A.  Jobert.  No.  1,  v.  1.  8°.  Alger  (1883). 

Revue  mensuelle  des  maladies  de  Fenfance.  ed.  Cadet  de  Gassicourt  and  L.  A. 

de  Saint-Germain,  v.  1-25,  Paris  (1883-1907).  8°. 

Archives  (The)  of  Pediatrics,  ed.  William  Perrv  Watson,  v.  1-39.  8°.  .Jersey 

City,  N.  J.  (1884);  Philadelphia  (1884-91); ‘New  York  (1892-1922). 

Archivos  de  medicina  y cirugia  de  los  ninos.  ed.  Baldomero  Gonzalez  Alvarez, 
v.  1-5.  8°.  Madrid  (1884-89). 

Obshtshestvo  Dietskich  Vrachei  v.  S.-Peterburg.  Trudi  I-X  (1885-96).  [So- 
ciety of  Pediatricians  . . . Memoirs.]  S°.  St.  Petersburg  (1887-96). 
Archivio  italiana  di  pediatria.  ed.  Giuseppe  Somma.  2 s.  v.  7-12.  8°.  Na- 

ples (1889-94).  Ended. 

Revista  de  enfermedades  de  la  infancia.  ed.  Jaime  Guerra  y Estape.  v.  1. 
8°.  Barcelona  (1890). 

American  Pediatric  Society.  Transactions.  8°.  [Philadelphia]  (1890-1922). 
Current. 

Beitrage  zur  Kinderheilkunde  aus  dem  I.  offentlichen  Ivinderkrankeninstitute  in 
Wien.  1.-3.  Hft.,  n.F.  v.  1-5.  8°.  Vienna  (1890-93). 

Congresso  pediatrico  italiano.  Atti.  1 (1890);  2 (1892);  3 (1898);  4 (1901). 
8°.  [v.p.]  (1891-1902). 

Kinderarzt  (Der).  Zeitschrift  ftir  Kinderheilkunde.  ed.  M.  Sonnenburger. 

v.  1-31.  8°.  Berlin  and  Neuwied;  Leipzig  (1890-1920). 

Boletin  del  Dispensario  f Hospital  de  ninos  pobres  de  Barcelona,  ed.  Juan  Roca. 
v.  1-7.  fol.  Barcelona  (1891-97). 

Igiene  dell’  infanzia  e medicina  preventiva.  ed.  Francesco  Rugieri.  v.  1-5. 
8°.  Rome  (1892-96). 

Obshtshestvo  Dietskich  Vrachei  sostoyashtshiy  pri  Imperatorskom  Moskovskom 
Universitetie.  Trudi.  . . v.  1—7  (1892— 3 to  1898— 9)  [Society  of  Pediatricians 
at  the  Imperial  Moscow  University.  Memoirs  . . .]8°.  Moscow  (1892-99). 
Journal  de  clinique  et  de  therapeutique  infantiles.  ed.  G.  Variot.  v.  1-7. 
Paris  (1893-99).  Merged  in  Gazette  des  maladies  infantiles. 


126 


HISTORY  OF  PEDIATRICS 


Nederlandsche  Vereeniging  voor  Psediatrie.  Voordrachten . . . v.  1-2.  8°. 

Utrecht  (1893-6). 

Pediatria  (La),  ed.  Francesco  Fede.  R.  Jemma,  v.  1-30.  8°.  (1893-1922). 

Current. 

Medecine  (La)  infantile,  ed.  Jules  Comby.  v.  1-4.  8°.  Paris  (1894-97). 
Centralblatt  fur  Kinderheilkunde.  ed.  Eugen  Graetzer.  v.  1-20.  8°.  Leipzig, 

(1896-1915).  Current.  In  1908,  title  became;  Zentralblatt  etc. 

Dietskaya  meditsina.  ed.  L.  P.  Alexandroff.  v.  1-8.  8°.  Moscow  (1896- 

1903) .  Ended. 

Pediatrics,  ed.  by  Dillon  Brown,  George  Carpenter  ( et  al ).  v.  1-28.  8°.  New 

York  and  London  (1896-1916). 

Annales  de  medecine  et  chirurgie  infantiles.  ed.  E.  Perier.  v.  1-18.  8°.  Paris 

(1897-1914). 

Medecine  (La)  infantile,  ed.  E.  P6rier.  H.  Roueche  v.  1-27.  8°.  Paris 
(1987-1911). 

Pratique  (La)  de  la  medecine  infantile,  ed.  E.  Perier.  v.  1.  8°.  (1897). 
Archives  de  medecine  des  enfants.  ed.  F.  Bran,  J.  Comby  [et  al.]  v.  1-25.  8°. 
Paris  (1898-1922). 

Gyermekgyogyaszat  [Pediatry],  v.  1-10.  fol.  and  8°.  Budapest  (1898-1907). 
Supplement  to:  Orvosi  hetilap. 

Infanzia  anormale.  Bulletino  ufficiale  della  Societa  italiana  pro  anomali.  v. 
1-14.  8°.  Milaro,  1898-1921. 

Tuberculose  (La)  infantile,  ed.  Leon  Derecq  and  Henri  Barbier.  v.  1-10.  8°. 

Paris  (1898-1907). 

Conferenze  d’igiene  infantile  tenute  per  cura  del  Comitato  romano  della  Societa 
Nazionale  Pro  Infantia  nell’  aula  dell’  Isituto  d’igiene  di  Roma  nell’  anno 
(1898).  230  pp.,  1 1.  8°.  Rome,  G.  Balbi  (1899). 

Gazette  des  maladies  infantiles.  Journal  de  psediatrie.  ed.  H.  Barbier  and 
Yillemin.  v.  1-14.  4°.  Paris  (1899-1912).  In  January,  1900,  Journal 

de  clinique  et  de  therapeutique  infantiles  merged  in  this  journal,  and  title 
became:  Gazette  des  maladies  infantiles  et  Journal  de  clinique  et  de  thera- 
peutique infantiles  reunis. 

Societe  de  pediatrie  de  Paris.  Bulletins,  v.  1-19.  8°.  Paris  (1899-1921). 

Igiene  dalla  prima  infanzia.  Atti  del  primo  Congresso  nazionale  per  l’igiene  dell’ 
allattamento  mercenario  (1899).  8°.  Milan  (1900). 

Paedologisch  Jaarboek.  ed.  M.  C.  Schuyten.  v.  1-5.  8°.  Antwerp  (1900- 

1904) . 

Society  for  the  Study  of  Disease  in  Children.  Reports  (1900-1901  to  1907-8). 
v.  1-8.  8°.  London  (1901-99). 

Congresso  per  l’igiene  dell’  allattamento  e la  tutela  della  prima  infanzia,  tenuto  in 
Firenze  (1901).  Atti.  8°.  Florence  (1903). 

Homoeopathic  (The)  Journal  of  Pediatrics,  ed.  J.  G.  Chadwick,  v.  1.  Buffalo, 
N.  Y.  (1902). 

Archivo  di  patologia  e clinica  infantile,  ed.  Tommaso  Guida.  v.  1-2.  8°. 

Naples  (1902-3). 

Gesellschaft  fur  innere  Medizin  und  Kinderheilkunde  in  Wien.  Mitteilungen. 

v.  1-21.  8°.  Vienna  (1902-22).  Current. 

Monatsschrift  fur  Kinderheilkunde.  ed.  Arthur  Keller,  v.  1-22.  8°.  Leipzig 

and  Vienna  (1902-1922). 

Revue  d’hygiene  et  de  medecine  infantiles,  et  Annales  de  la  polyclinique  H.  de 
Rothschild,  ed.  H.  de  Rothschild,  v.  1-10.  8°.  Paris  (1902-11). 

Congresso  nazionale  “pro  infantia”  in  Torino  (1902).  Atti.  8°.  Turin  (1903'. 
Gyermekorvos.  [The  children’s  physician.]  v.  1-12.  4°.  Budapest  1903- 

14).  Supplement  to  Budapesti  orvosi  ujsag. 

Pediatrie  (La)  pratique,  ed.  E.  Ausset.  v.  1-12.  sm.  4°  (1903-13). 

Rivista  di  clinica  pediatrica.  ed.  C.  Comba,  [et  al.]  v.  1-20.  8°. 

Florence  (1903-21). 

British  (The)  Journal  of  Children’s  Diseases,  ed.  George  Carpenter.  J.  D. 
Rolleston.  v.  1-19.  8°.  London  (1904-22).  Current. 


OBSTETRIC,  GYNECOLOGIC  AND  PEDIATRIC  PERIODICALS  127 


Halbmonatsschrift  fur  Frauen-  und  Kinderkrankheiten.  ed.  S.  Schick,  v.  1-2. 
8°.  Vienna  (1904-5). 

Philadelphia  Pediatric  Society.  Transactions  (1904K5,  1905-6).  8°.  New 

York  (1905-6). 

Archives  Latino- Americanos  de  pediatria.  v.  1-13.  8°.  Buenos  Aires 

(1905-1919). 

Jikwa  Zasshi  [Journal  of  Pediatrics.]  Nos.  75-78.  8°.  Tokyo  (1906). 

Zeitschrift  fur  Kinderheilkunde.  ed.  H.  Finkelstein  [et  al]  Original.  Zeitschrift 
fur  KinderfSege.  v.  1-9.  8°.  Berlin,  1906-14.  Referate : Zentralblatt  fur 

die  gesamte  Kinderheilkunde  ed.  H.  Finkelstein  v.  1-12.  8°.  Berlin 

(1910-22)  Current. 

Przeglad  Pedyatryczny  [Pediatric  Review]  v.  1-6.  .8°  Krakow,  1908-14. 
Rassegna  di  pediatria.  v.  1—5.  40.  Parma,  1910-14.  Pediatriya.  v.  1-6.  8°. 

Petrograd,  1911-14. 

Pediatria  (La)  espanola.  v.  1-11.  8°.  Madrid  (1912-22).  Current. 

Association  internationale  de  pediatrie;  premier  congres  tenu  a Paris,  les  7,  8,  9, 
Octobre  (1912).  8°.  Paris  (1913). 

Le  Nourisson,  ed.  A. -B.  Marfan,  v.  1-10.  8°.  Paris,  1913-22. 


COMBINED  OBSTETRIC  GYNECOLOGIC  AND  PEDIATRIC  PERIODICALS 

Archiv  fiir  die  Geburtshulfe,  Frauenzimmer-  und  neugebohrner  Kinderkrankheiten. 
v.  1-6  (a  4 Stiicke)  8°.  Jena  (1787-96).  Continued  by  the  following. 

Neues  Archiv  fiir  die  Geburtshiilfe,  Frauenzimmer-  und  Kinderkrankheiten. 
v.  1 (a  4 Stiicke).  8°.  Jena  (1798-1800). 

Annalen  der  Geburtshulfe,  Frauenzimmer-  und  Kinderkrankheiten.  Fiir  die 
Jahre  (1790  und  1791).  ed.  Jacob  Romer.  2v.  8°.  Winterthur  (1793-94). 

Annalen  der  klinischen  Anstalten  der  Universitat  zu  Breslau,  fiir  Geburtshiilfe  und 
Krankheiten  der  Weiber  und  Kinder,  ed.  J.  W.  Betschler.  v.  1-2.  8°. 

Breslau  (1832-34). 

Beitrage  zur  theoretischen  und  practischen  Geburtshulfe  und  zur  Kenntniss  und 
Kur  einiger  Kinderkrankheiten.  ed.  J.  H.  Wigand,  Heft.  1-3.  8°.  Ham- 

burg (1798-1808). 

Neues  Archiv  fiir  die  Geburtshiilfe,  Frauenzimmer-  und  Kinderkrankheiten.  ed. 
Joh.  Christian  Stark,  v.  1-3.  Jena  (1798-1801). 

Journal  fiir  Geburtshiilfe,  Frauenzimmer-  und  Kinderkrankheiten.  ed.  Elias  von 
Liebold.  v.  1-17.  8°.  Frankfurt  am  Main  (1813-33);  Leipzig  (1834-38). 

Annales  de  gynecologie  et  de  pediatrique.  Par.  Martin  Schoenfeld.  2 s.,  v.  1-2. 
roy.  8°.  Brussels  (1840-42). 

Annales  d’obstetrique,  des  maladies  des  femmes  et  des  enfans.  ed.  Andrieux  de 
Brioude  and  Lubanski.  v.  1-3.  8°.  Paris  (1842-43). 

Nederlandsch  Tijdschrift  voor  Verloskunde,  Ziekten  der  Vrouwen  en  der  Ivinderen. 
ed.  J.  Broers.  v.  1-16.  8°.  Utrecht  (1846—53). 

Nederlandsch  Tijdschrift  voor  Heel-  en  Verloskunde,  Ziekten  der  Vrouwen  en  der 
Kinderen.  N.s.  v.  1—11.  8°.  Utrecht  (1854-69).  Continuation  of  pre- 

ceding. 

Tijdschrift  der  Nederlandsche  Gynaecologie  en  Paedriatiek.  ed.  H.  J.  Broers. 
St.  1-4.  8°.  Utrecht  (1847-48). 

American  Journal  of  Obstetrics  and  Diseases  of  Women  and  Children,  ed.  by  E. 
Noeggerath,  B.  F.  Dawson  and  A.  Jacobi,  v.  1-80.  8°.  New  York  (1868- 

1919). 

Woman’s  Pacific  Coast  Journal,  ed.  Mrs.  Carrie  F.  Young,  v.  1-2.  4°.  San 

Francisco  (1870-71). 

Gazette  obstetricale  de  Paris,  ed.  E.  Vernier  (de  Villers).  v.  1-9.  8°.  Paris 

(1872-80). 

Obstetrical  (The)  Journal  of  Great  Britain  and  Ireland.  With  an  American 
supplement,  ed.  William  F.  Jenks.  v.  1-8.  8°.  Philadelphia  (1873-80). 


128 


HISTORY  OF  PEDIATRICS 


Archives  de  tocologie,  des  maladies  des  femmes  et  des  enfants  nouveau-nes.  ed. 

J.  A.  H.  Depaul.  v.  1-15.  8°.  Paris  (1874-91). 

Obstetric  (The)  Gazette,  ed.  Edward  B.  Stevens,  v.  1—13.  8°.  Cincinnati 

(1878-90). 

Homoeopathic  (The)  Journal  of  Obstetrics  and  Diseases  of  Women  and  Children. 

ed.  by  Henry  Minton,  v.  10-26.  8°.  New  York  (1879-1904). 

Annali  di  ostetricia,  ginecol6gia  e pediatria.  ed.  Domenico  Chiara  [et  al.]  v.  1-37. 

8°.  Milan  (1879-87);  Florence  (1888-9);  Milan  (1890-1915). 

Anales  de  obstetrica,  ginecopatia  y pediatria.  ed.  Rafael  Ulecia  y Cardona, 
v.  1-19.  8°.  Madrid  (1881-99). 

Hygiene  (L’)  de  la  femme  et  de  et  de  l’enfant.  ed.  Madeleine  Bres.  v.  1-3.  4° 

Paris  (1883-85). 

Tennessee  Journal  of  Medical  and  Surgical  Diseases  of  Women  and  Children. 

ed.  by  H.  J.  Wells.  Nos.  1-2,  v.  1.  8°.  Nashville,  Tenn  (1884). 

Archivos  de  ginecologia  y enfermedades  de  la  infancia.  ed.  P.  Calderin,  Manuel 
de  Tolosa  Latour.  v.  1-2.  8°.  Madrid  (1884-85). 

Progreso  (El)  ginecoldgico  y pediatria.  ed.  Candela  P14.  v.  1-3.  8°.  Valencia 

(1884-89). 

Revue  obstetricale  et  gynecologique  (accouchements,  maladies  des  femmes  et 
des  enfants).  ed.  Apostoli,  Boursier  [et  al.]  v.  1-12.  8°.  Paris  (1885-96). 

Allgemeine  Zeitschrift  fur  Hebammen,  Wochen-  und  Kinderpflege.  ed.  O. 

Zeller,  v.  1-2.  4°.  Stuttgart  (1885-86). 

Archives  (The)  of  Gynaecology,  Obstetrics  and  Pediatrics.  8°.  v.  1-9.  New 
York  (1886-94). 

Revue  pratique  d’obstetrique  et  d’hygiene  de  l’enfance.  ed.  MM.  Henri  Yarnier 
and  Paul  Le  Gendre.  v.  1-26.  8°.  Paris  (1888-1913). 

Progreso  (El)  ginecologico  y pediatria.  v.  1-3.  8°.  Valencia  (1887-89). 

Revue  obstetricale  et  gynecologique.  v.  5-12.  8°.  Paris  (1889-96). 

Annals  of  Gynaecology  and  Paediatry.  Philadelphia.  (Title  after  February, 
1890  (v.  3,  No.  5)  of  Annals  of  Gynaecology,  Boston. 

Congres  periodique  de  gynecologie,  d’obstetrique  et  de  paediatrie.  Ire.  session, 
Bordeaux  (1895).  2.  Marseille  (1898).  3.  (1901).  4 (1904).  Memoires 

et  discussions.  8°.  Paris,  Marseille,  Rouen  (1896-1905). 

Revue  mensuelle  de  gynecologie,  obstetrique  et  paediatrie  de  Bordeaux,  ed.  R. 

Lefour.  v.  1-5.  8°.  Bordeaux  and  Paris  (1899-1903). 

Obstetrique  (L’).  ed.  P.  Budin.  v.  1-12.  8°.  Paris  (1S96-1907). 

Kalender  fur  Frauen-  und  Kinder- Aerzte.  ed.  Franz  Eichholz.  v.  1-10.  12°. 
Bad.  Kreuznach  (1897-1906). 

Clinica  (La)  ostetrica.  ed.  Felice  La  Torre,  v.  1-9.  8°.  Rome  (1899-1907). 

Societe  d’obstetrique,  de  gynecologic  et  de  paediatrie  de  Paris.  Comptes  rendus. 
v.  1-13.  8°.  Paris,  1899-1911. 

Giornale  di  ginecologia  e di  pediatric,  ed.  A.  Pinna-Pintor.  v.  1-7.  8°.  Turin 

(1901-7). 

Revue  pratique  (mensuelle)  de  gynecologie,  d’obstetrique  et  de  pediatrie.  ed. 
Louis  Pierra.  v.  1-9.  Paris  (1906-14). 


PERIODICALS  DEVOTED  TO  CHILD -STUDY,  PEDAGOGICS  AND  SCHOOL 

HYGIENE 

Societe  libre  de  i’etude  psychologique  de  l’enfant.  v.  1-31.  S°.  Paris,  1882— 

1913. 

Congreso  h i g i e n i e o - p e d a g 6 g i c o . Memorias  del  primer  . . reunio  en  la  ciudad 
de  Mexico  el  ano  de  (1882).  8°.  Mexico  (1883). 

Revista  de  hygiene  y educacion  de  los  ninos.  ed.  Lutgardo  Nadal.  v.  1-2. 
(Nos.  1-14).  San  Fernando  (1885-6). 

Protector  (El)  de  la  infancia.  ed.  Eusebio  G6mez  del  Castillo,  v.  1—3. 
sm.  fob,  Barcelona  (1884—86). 


PERIODICALS  DEVOTED  TO  INFANT  HYGIENE  AND  WELFARE  129 


Zeitschrift  fur  Schul  gesundheitspflege.  ed.  Dr.  Kotelmann;  P.  Stephani. 
v.  1-35.  8°.  Hamburg  and  Leipzig  (1888-1922). 

M 'dizinisch-padagogische  Monatsschrift  flir  die  gesammte  Sprachheilkunde  mit 
Einschiuss  der  Hygiene  der  Lautsprache.  ed.  Albert  Gutzmann,  Herm. 
Gutzmann.  v.  1-12.  8°.  Berlin  (1891-1902). 

Pedagogical  Seminary,  ed.  G.  Stanley  Hall.  v.  1-22.  Worcester,  Mass.  (1891— 
1922). 

Childhood,  ed.  by  G.  W.  Winterburn  and  Florence  .Hull.  v.  1-3.  8°.  New 

York  (1892-1894). 

Ortofrenia  (L’).  v.  1.  roy.  8°.  Lecco  (1894-5). 

Zeitschrift  fur  Kinderschutz  und  Jugendfiirsorge.  Hrsg  von  der  Zentralstelle  flir 
Kinderschutz  und  Jugendfiirsorge  in  Wien.  v.  1-13.  4°.  Wien,  1899-1921. 

Z oschrift  flir  padagogische  Psychologie,  Pathologie  und  Hygiene,  ed.  Ferdi- 
nand Kemsies  and  Leo  Hirschlaff.  v.  4-8.  8°.  Berlin  (1902-6). 

lgres  d’hygiene  scolaire  et  de  pedagogie  physiologique.  Rapports  et  com- 
munications. v.  1-2  (1903-5).  8°.  Paris  (1904-6). 

Schularzt  (Der).  v.  1-4.  8°.  Hamburg  (1903-6).  Supplement  to:  Zeit- 
schrift flir  Schulgesundheitspflege. 

Training  School  Bulletin,  ed.  E.  R.  Johnstone,  v.  1-14.  Vineland,  N.  J. 
(1904-17). 

Rebvonok  [Child.]  Nos.  1-8.  4°.  Petrograd  (1905). 

Internationales  Archiv  flir  Schulhygiene.  ed.  Sir  Lauder  Brunton.  v.  1-3. 
8°.  Leipzig  (1905-7). 

Kind  (Das),  ed.  Eugen  Neter.  v.  1.  8°.  Hannover  (1906-7). 

Zeitschrift  flir  Erforschung  und  Behandlung  der  jugendlichen  Schwachsinnigen. 
v.  1-7.  8°.  Jena,  1906-14. 

Journal  of  Educational  Psychology,  ed.  J.  Carleton  Bell.  v.  1-13.  Baltimore 
(1910-1922). 

Child  (The),  ed.  Theophilus  N.  Kelynack.  v.  1-12.  8°.  London  (1910-22). 

Child  (The)  ed.  David  R.  Blyth.  8°.  ' Chicago  (1912-13). 

L’Enfance  anormale.  v.  1-3.  8°.  Paris,  1912-14. 

L’Enfance.  v.  1.  8°.  Paris,  1913-14. 

International  Record  of  Child  Welfare  Work.  Organ  of  the  International 
Association  for  the  Promotion  of  Child  Welfare.  Vol.  I.  8°.  Brussels, 
921-22. 


PERIODICALS  DEVOTED  TO  INFANT  HYGIENE  AND  INFANT  WELFARE 

Igiene  (L’)  infantile,  ed.  C.  Musatti.  v.  1-6.  8°.  Venice  (1878-84). 

Mai  (A)  de  familia.  ed.  Carlos  Costa,  v.  1-2.  roy.  8°.  Rio  de  Janeiro  (1879- 
80). 

Nouveau-ne  (Le).  ed.  Oscar  Comettant.  v.  1-6.  8°.  Paris  (1881-86). 

Soe  edad  protectora  de  los  ninos.  Boletin.  v.  1-6.  Madrid  (1881-86). 

Maire  (La)  y el  nino.  ed.  Manuel  de  Tolosa  Latour.  v.  1-5.  fol.  Madrid 
(1883-88). 

Hospital  (El)  de  ninos.  ed.  Manuel  de  Tolosa  Latour.  v.  1-4.  (2.  epoca). 

fol.  Madrid  (1884-8). 

Babyhood,  v.  1-13.  8°.  New  York  (1884-97). 

Ba  yhood.  ed.  Leroy  M.  Yale.  v.  1-25.  8°.  New  York  (1884-1909). 

Mamma  e bambino,  ed.  Raimondo  Guaita.  v.  1-2.  roy.  8°.  Milan  (1884—85). 

Mere  (La)  et  l’enfant.  ed.  T.  Caradec.  v.  1-2.  fol.  Paris  (1885-86). 

Providenza  baliatica.  ed.  Antonio  Ripamonti.  v.  1-2,  Nos.  1-10.  fol.  Milan 
(1886-87). 

; dletin  (Le)  des  nourrices  au  sein  [d’Indre-et  Loire],  ed.  Edmond  Chaumier. 
v.  1-3.  8°.  Grand-Pressigny  (Indre-et-Loire)  (1886-88). 

Philanthropic  (The)  Index  and  Review.  Published  in  the  interests-  of  feeble- 
minded children,  ed.  Dr.  C.  T.  Wilbur,  v.  1-7,  fol.  Kalamazoo,  Mich. 
(1882-86). 

Vol.  1—9 


130 


HISTORY  OF  PEDIATRICS 


Baby,  Nos.  1-3.  4°.  London  (1887-8). 

M6re  (La)  et  l'enfant.  ed.  Severin  Lachapelle.  Nos.  1-7,  v.  1.  8°.  Montreal 

(1890). 

Gesunde  Kinder,  ed.  H.  Moser,  v.  1-2.  8°.  Magdeburg  (1892-94).  Ended. 

Bulletin  (Le)  des  nourrices  au  sein  [d’Indre-et-Loire].  v.  1-4.  8°.  Grand-Pres- 

signy  (1896-99). 

Gesunde  Kinder,  ed.  H.  Moeser.  v.  1-4.  8°.  Hamm  i.  W.  (1896-99). 

Gesunde  Kinder.  Gesunde  Frauen,  ed.  J.  Groll.  v.  5-8.  8°.  Berlin  (1896— 

1903). 

Maternity  and  Child  W elfare.  Official  Organ  of  the  Central  Council  for  Infant  and 
Child  Welfare,  v.  1-6.  4°.  London,  1897-1922. 

Medicina  (La)  de  los  ninos.  ed.  A.  Martinez  Vargas.  8°.  Barcelona  (1900- 
1907). 

Zeitschrift  fur  Sauglingsfiirsorge.  ed.  B.  Salge.  v.  1-10.  8°.  Leipzig,  1906- 

18. 

Zeitschrift  fur  Sauglings-und  Kleinkinderschutz.  Organ  des  Kaiserin  Auguste 
Victoria-Hauses  und  der  Deutschen  Vereinigung  fur  Sauglingsschutz.  v.  1—13. 
8°.  Berlin,  1909-21. 

Nipiologia.  v.  1-4.  8°.  Napoli,  1915-18. 

Mother  and  Child.  Published  by  American  Child  Hygiene  Association,  ed. 
John  A.  Foote  and  Ellen  C.  Babbitt  v.  1-3.  8°.  Baltimore,  1920-22. 


THE  TWENTIETH  CENTURY 
Social  or  Preventive  Pediatrics 

“Spake  I not  unto  you,  saying:  Do  not  sin  against  the  child,”  Genesis,  XLII,  22. 

In  the  twentieth  century,  pediatrics  was  elevated  from  its  ancillary 
status  as  a “dependent  dwarf”  of  ordinary  medical  practice,  into  the 
larger  atmosphere  of  social  medicine,  of  which  it  is  now  one  of  the  most 
important  independent  branches.  This  was  due  to  the  menace  of 
infant  mortality  as  the  chief  cause  of  the  depopulation  of  modern  states, 
with  the  consequent  extension  of  the  science  of  infant  nutrition  and 
metabolism  and  the  creation  of  the  new  science  of  infant  welfare,  as 
ways  and  means  of  combatting  the  evil.  It  has  been  the  universal 
experience  in  all  times  and  places,  that  the  mortality  of  hand-fed 
infants  is  higher  than  that  of  the  breast-fed.  In  this  regard,  it  is 
highly  significant,  as  Heubner  says,  that  while  the  science  of  infant 
diseases  and  their  treatment  is  a plant  of  almost  recent  growth,  the 
generic  idea  of  the  importance  of  infant  welfare,  as  the  basis  of  racial 
or  national  hygiene,  has  excited  human  interest  from  time  immemorial. 
The  modern  movement  is  only  the  logical  expansion  of  a folk-intuition 
or  schwebender  Gedanke,  which  exists,  in  crude  form,  even  among  semi- 
civilized  peoples. 

The  Science  of  Infantile  (Nutritional)  Disorders* 

Through  the  work  of  Bichat,  as  we  have  seen,  the  attention  of 
Billard  and  other  pediatrists  of  his  time  was  directed  to  the  post- 

* In  attempting  to  deal  with  the  complex  subject  of  infant  nutrition  and 
metabolism,  I wish  to  acknowledge  my  indebtedness  to  the  address  of  O.  Heubner; 
“Zur  Geschichte  der  Saiiglingsheilkunde”  (Berlin,  1909),  and  to  the  valuable 
information  conveyed  by  Drs.  Isaac  A.  Abt  (Chicago),  John  Ruhrah  (Baltimore) 
and  John  Foote  (Washington,  D.  C.). 


THE  SCIENCE  OF  INFANTILE  DISORDERS 


131 


mortem  lesion  as  the  basis  of  classification  of  infantile  diseases;  and 
this  tendency,  gathering  impetus  from  the  massive  achievement  of 
Virchow  and  Rokitansky,  continued  straight  on  to  the  latter  part  of 
the  nineteenth  century.  In  other  words,  it  was  nowise  perceived  that 
post-mortem  findings  are  but  end-results  of  a long  series  of  chemical 
changes  within  the  body,  and  that  the  true  cause  of  disease  and  basis  of 
classification  is  to  be  sought  in  the  initial  rather  than  the  final  state  of 
these  changes.  Thus,  the  classification  of  gastro-intestinal  diseases 
in  infancy  was  for  a long  time  confused  by  the  Broussais  theory  of 
gastro-enteritis  and  irritation  as  the  basis  of  pathology,  and  the  concept 
“softening  of  the  stomach,”  which  John  Hunter,  and  latterly  Heubner 
himself,  defined  as  mere  post-mortem  auto-digestion  (an  end-result), 
was  accepted  in  Billard’s  time,  as  a clinical  and  pathological  “entity.” 
Bednar  described  the  various  toxemias  of  infancy  with  care  (1850-53) 
but  he  did  not  see  their  relation  to  the  disorders  of  infant  nutrition 
(Heubner). 

An  apparent  step  forward  was  taken  when  Parrot  maintained  that 
severe  diseases  of  infants  lead  back  to  some  mysterious  deep-lying 
disturbance  or  “athrepsia,”  of  the  whole  infantile  organism;  but 
Parrot,  as  Heubner  points  out,  did  not  reason  in  terms  of  metabolism, 
but  again  considered  only  post-mortem  findings,  and  Hutinel  main- 
tains that  the  cause  of  athrepsia  was  simply  hospital  sepsis  and  the 
dirty  hands  of  the  attendants.  The  expression  “metabolic  pheno- 
mena” was  first  employed  by  Theodor  Schwann  in  1839  (Fraser 
Harris).  The  generic  concept  ( Stoffwechsel ) was  made  more  familiar 
in  the  “Organic  Chemistry”  of  Liebig  (1842),  who  classified  the 
organic  foodstuffs,  made  a thorough  investigation  of  the  metabolism 
of  mineral  salts,  and  even  made  some  attempt  to  improve  infant 
nutrition  by  the  addition  of  digestible  carbohydrates  to  animal  milk  as 
a substitute  or  “surrogate”  for  maternal  milk  (Liebig’s  Food).  In 
1837,  L.  T.  W.  Bischoff  first  demonstrated  the  presence  of  free  oxygen 
and  C02  in  the  blood  and  studied  the  urea  as  a measure  of  chemical 
interchange  in  the  body.  In  1838,  Johann  Friedrich  Simon  [1807-43], 
of  Berlin,  made  a chemical  and  physiological  investigation  of  human 
milk  in  comparison  with  animal  milk.  * This,  in  the  opinion  of  Heub- 
ner, is  the  first  real  landmark  in  the  exact  science  of  infant  metabolism 
as  a basis  for  rational  infant  nutrition.  The  investigation  passed 
unnoticed  for  some  thirty  years.  “The  fundamental  concept  of 
disease  remained  fast-rooted  in  the  anatomical  lesion,  the  theory  of 
treatment  conscientiously  limited  itself  to  a number  of  drugs  designed 
to  combat  that  lesion  ” (Heubner) . But  the  general  idea  that  disorders 
of  infant  nutrition  are  to  be  treated  not  by  drugs  but  by  correct  diet  was 
gaining  ground,  and  the  work  of  Biedert,  Jacobi,  and  others  on  infant 
nutrition  was  not  without  results.  The  pediatrists  of  the  Vienna  school, 
Mayr  and  Widerhofer,  attained  the  most  refined  semeiology  in  their 

* Simon,  J.  F.,  De  lacte  muliebris  ratione  chemica  et  physiologica,  Berlin 
dissertation  (1838).  Also,  German  translation,  Die  Frauenmilch,  etc.,  Berlin, 
(1838). 


132 


HISTORY  OF  PEDIATRICS 


clinical  delineations,  through  the  use  of  instruments  of  precision. 
Kiittner,  a Dresden  pediatrist  of  the  same  type,  said  frankly  “He 
who  would  cure  sick  children  must,  before  all  else,  know  how  to 
feed  them.”  Franz  Soxhlet  furthered  the  cause  of  pure  milk  by  intro- 
ducing the  idea  of  “surgical  asepsis  in  the  hygiene  of  cow-stalls” 
and  the  sterilization  of  milk  (Heubner).  Epstein  and  Grancher  carried 
over  the  same  asepsis  into  the  children’s  wards.  In  1878,  the  obstetri- 
cian Friedrich  Ahlfeld  (1843-  ),  at  Leipzig,  introduced  the  use  of 

the  balance  in  weighing  infants  in  connection  with  growth  and  metabo- 
lism;* and  a number  of  women  physicians  established  the  basic  data  by 
weighing  their  own  infants  at  suckling  during  the  whole  period  of 
lactation.  This  led  to  an  entirely  new  concept,  that  of  the  “nutritive 
requirement,”  of  the  suckling  infant.  In  the  meantime,  Carl  Berg- 
mann,  in  1847,  emphasized  the  relation  between  heat  production  and 
surface  area  of  the  body,f  which  was  also  to  be  forgotten  until  Rubner 
again  brought  it  forward  (1883);  Voit  and  Pettenkofer  estimated  the 
amounts  of  proteins,  fats  or  carbohydrates  broken  down  in  the  body 
(from  the  total  nitrogen  and  carbon  dioxide  eliminated)  by  a special 
respiration  chamber  (1861);  and  Voit  introduced  new  methods  for 
determining  the  intake  and  outgo  in  the  balance  of  nutrition  and  the 
amount  of  proteid  necessary  in  foods.  Paul  Zweifel  demonstrated 
pepsin  in  the  stomach  and  diastase  in  the  parotid  of  the  newborn 
(1874)4  Joseph  Forster,  in  the  earliest  investigation  of  the  gaseous 
metabolism  of  the  new-born,  made  with  a Pettenkofer- Voit  respiration 
chamber,  showed  that  the  infant  produces  more  CCL  per  unit  weight 
than  the  adult  (1877). § Epstein  studied  the  duration  of  gastric  diges- 
tion in  infancy  (1880-87).  Johann  Kjeldahl  introduced  his  method  of 
estimating  nitrogen  content  in  (1883).  Max  Rubner  found,  that  the 
metabolism  is  proportional  to  the  surface  energy  of  the  body  (1883)  and 
investigated  metabolic  changes  in  terms  of  heat  and  energy  units  by 
calorimetry  (1891-1902).  Wilhelm  Camerer  introduced  the  scientific 
investigation  of  infantile  metabolism  in  the  pediatric  clinic  (1894). 
Improved  calorimeters,  such  as  those  of  d’Arsonval  (1886),  Atwater 
and  Rosa  (1897),  Atwater  and  Benedict  (1905)  were  invented;  and, 
in  1898-99,  Rubner  and  Heubner  published  their  epoch-making  mono- 
graphs on  the  average  daily  food  requirements  of  the  normal  and  the 
atrophic  infant,  which  are  the  starting  point  all  of  modern  work  on 
infant  metabolism.  The  theory  of  disordered  infantile  nutrition  now 
followed  three  distinct  and  separate  trends.  Escherich,  in  1886,  first 
signalized  the  importance  of  the  bacterial  flora  of  the  intestine  as 
pathogenic  agents  in  infantile  disease  (1885)  and  postulated  an  infec- 

* Ahlfeld,  “Ueber  Ernahrung  des  Singlings  an  der  Mutterbrust;  fortlaufende 
Wagungen  wahrend  der  Sauglingsperiode.”  Leipzig  (1878). 

f Bergmann,  “Ueber  Verhaltnisse  der  Warmeokonomie  der  Thiere  zu  ihrer 
Grosse,”  Gottingen  (1848). 

t Zweifel,  “Untersuchungen  fiber  den  Verdauungsapparat  der  Neugeborenen,” 
Berlin  (1874). 

§ Forster,  “Amtl.  Ber.  d.  50.  Versamml.  deutsch.  Naturf.  u.  Aerzte, " Miin- 
chen  (1877),  p.  355. 


THE  SCIENCE  OF  INFANTILE  DISORDERS 


133 


tious,  endogenous,  toxic  gastroenteritis  or  milk-infection  (1900), 
although  no  specific  bacillus  was  found.  Czerny  and  Keller  main- 
tained that  disturbances  of  nutrition  may  spring  from  overfeeding, 
especially  with  fats,  from  infection  (enteral  and  parenteral),  from 
inborn  defective  metabolism  (exudative  diathesis),  and  from  congenital 
defects.  Czerny  drew  attention  from  pathological  processes  in  the 
intestinal  tract  to  the  intermediate  metabolism  in  outlying  organs  and 
cells  of  the  body;  and  the  fact  that  nitrogen  was  excreted  in  the  urine 
as  ammonia  instead  of  urea  suggested  an  abnormal  excess  or  an  insuffi- 
cient breaking  down  of  acids  in  the  organism.  Schlossmann  taught 
the  straight  doctrine  that  artificial  feeding  is  “unnatural  feeding.” 
Finkelstein,  reasoning  from  clinical  appearances,  argued  that  infantile 
diseases  are  due  to  disturbances  of  balance  of  nutrition,  to  dyspepsia 
(diminished  tolerance),  to  decomposition  (Parrot’s  athrepsia)  and 
to  intoxication  (enterocatarrh,  cholera  infantum).  In  1906,  Finkel- 
stein opposed  the  Biedert  theory  that  casein  is  harmful,  the  Czerny 
theory  that  fats  are  harmful,  the  Escherich  theory  that  bacteria 
are  harmful  in  the  infantile  digestive  tract,  and  the  Rotch  theory 
of  percentage  feeding  to  offset  the  harmfulness  of  proteids,  and 
advanced  the  theory  of  an  alimentary  fever  from  sugar  or  salt,  with 
a special  “albumen  milk,”  to  meet  these  conditions.  Finkelstein’s 
Eiweissmilch,  a mode  of  therapy  rather  than  an  infant  food,  shows 
that  proteids  are  not  necessarily  harmful,  but  his  theory  of  salt- 
and  sugar-fevers  was  opposed  to  such  purpose  that  he  himself  ulti- 
mately abandoned  his  dogmatic  position  as  to  the  pyrogenic  action 
of  carbohydrates,  and  finally  came  around  to  Czerny’s  view  that  fats 
are  more  harmful  than  casein  in  a bowel  previously  irritated  by  sugar 
fermentation  (1910).  Ingestion  of  sugar  has  been  pushed  to  the  point 
of  “sugar-diarrhea”  by  Orgler  (1908),  Allen  (1913),  Talbot  and  Hill 
(1914),  without  any  evidence  of  sugar  intoxication.  The  chief  danger 
of  sugar  to  the  infant  would  appear  to  be  that  it  is  a culture-medium  for 
the  growth  of  bacteria  in  the  intestinal  tract.  But,  whatever  view- 
point is  assumed,  the  mystery  of  the  disorders  of  infant  metabolism, 
which  cause  the  baby  to  die  incontinently  or  to  sink  helplessly  into 
dissolution,  is  still  to  be  unravelled,  as  Heubner  says,  in  the  conditions 
leading  to  a pathological  lesion  of  the  infantile  intestinal  tract. 

The  subject  of  infant  metabolism  and  nutrition  has  been  a debate- 
able  land,  made  up  of  the  shifting  sands  of  theory.  The  history  of 
metabolism  itself  may  be  likened  to  a succession  of  dissolving  views. 
The  assemblage  of  the  different  theories  has  all  the  effect  of  Schopen- 
hauer’s concert  of  Russian  horns,  each  player  producing  (in  his  place) 
a single  isolated  note.  Ruhrah  likens  the  different  ways  of  approach- 
ing metabolism  to  Saxe’s  poem  “The  Six  Blind  Men  and  the  Elephant.” 
The  energy-metabolism  is  computed  1)  by  measuring  the  heat  lost  in  the 
calorimeter, 2)  by  obtaining  the  heat  from  the  respiratory  quotient 
(volume  of  oxygen  inspired  into  volunte  CO*  expired)  in  a respiration 
chamber.  The  basal  metabolism  (at  absolute  rest)  is  hard  to  compute 
in  infants,  on  account  of  the  kicking  and  crying  of  the  baby,  which 


134 


HISTORY  OF  PEDIATRICS 


increases  heat  production  (Schlossmann  and  Murschhauser).  The 
large  differences  between  the  energy-quotients  obtained  by  Heubner 
and  by  Czerny-Keller  show  that  the  Heubner  school  dealt  with  livelier 
babies  than  the  Czerny  school  (Talbot).  Finally,  after  18  hours  fast- 
ing in  a calorimeter,  Schlossmann  found  acetone  appears  in  the  urine 
(Schlossmann  and  Murschhauser),  suggesting  that  the  baby  may  have 
passed  from  a normal  to  a pathological  condition,  beyond  which  point 
basal  metabolism  cannot  be  computed.  In  applying  the  principles  of 
metabolism  to  infant  nutrition,  the  advocates  of  a single  isolated 
hypothesis,  in  comparison  with  the  resourceful  therapists,  become  as 
Emerson’s  “monotones,  the  men  of  one  idea.”  Jacobi  has  shown  that 
a marasmic  infant,  fed  up  to  normal  and  beyond  it  by  a monotone  of 
Eiweissmilch,  ultimately  developed  scurvy,  to  be  relieved  again  by  a 
more  varied  diet.  Thus  to  indulge  the  “vanity  of  dogmatizing”  in  the 
matter  of  infant  metabolism  is  to  join  the  ranks  of  those  who,  in  the 
expression  of  Harvey  Cushing  “are  today,  but  may  not  be 
tomorrow.”* 


Scientific  Investigation  of  Infant  Metabolism  and  Infant  Nutrition 

William  Camerer  (1842-1910)  of  Urach  (Wlirttemberg),  a Tubingen 
medical  graduate  (1866),  served  as  a medical  officer  in  the  Austro- 
Prussian  and  Franco-Prussian  wars  (1866-70),  and  later  specialized  in 
metabolic  disorders  in  his  private  clinic.  He  published  monographs  on 
obesity  (1886),  diathetic  disorders  (1888)  and  an  important  treatise  on 
the  metabolism  and  energy  requirements  of  childhood  from  birth  to  full 
growth  (1894,  2d.  ed.,  1896),  based  upon  his  own  close  observations. 
This  won  the  Stiebel  Prize  (1898)  and  was  followed  by  his  studies 
(with  Soldner)  of  the  composition  of  human  milk  (1895-1903)  and  of 
changes  of  weight  in  283  infants  in  the  first  year  of  life. 

Johann  Otto  Leonhardt  Heubner  (1843-  ),  a pupil  of  Wider- 

hofer  (Vienna)  and  an  assistant  of  Wunderlich  (Leipzig),  graduated  at 
Leipzig  (1867),  served  as  a medical  officer  in  the  Franco-Prussian  war, 
and  became  professor  extraordinarius  of  internal  medicine  at  Leipzig 
(1873)  and  director  of  the  University  Polyclinic  (1876).  In  1891, 
he  secured  the  erection  of  a children’s  hospital  at  Leipzig  and  became 
the  first  professor  of  pediatrics  in  the  University.  In  1894,  he  suc- 
ceeded Henoch  at  Berlin,  the  first  full  professorship  in  Germany,  with 

* If  the  above  expression  of  opinion  seems  exaggerated,  let  me  call  attention 
to  Schlossmann’s  address  of  1908  (Deutsche  med.  Wochenschrift,  1908,  xxxiv, 
(1713-1715),  in  which  he  says  that  “Investigations  in  infant  nutrition  are  legion, 
but  the  master  word,  fusing  all  into  a harmonious  whole,  remains  yet  to  be  spoken.” 
Schlossmann  cites  the  utterances  of  Goethe  (“Investigations  of  the  first  order  are 
all  the  more  valuable,  because  incomplete,  just  as  those  of  a lesser  order  are 
always  completed”);  and  of  Liebig  (“Modern  physiology  lacks  a great  centric 
idea  to  which  all  investigations  must  inevitably  converge;  hence  the  perpetration 
of  some  colossal  error  in  this  science  would  be  a positive  advantage”).  Equally 
apposite  is  Lord  Bacon’s  dictum  “It  is  easier  to  evolve  truth  from  error  than 
from  confusion.” 


INFANT  METABOLISM  AND  INFANT  NUTBITION 


135 


the  directorship  of  the  Pediatric  Clinic  and  Polyclinic  at  the  Charite- 
He  published  contributions  to  internal  military  medicine  (1871),  an 
epoch  making  study  of  syphilis  of  the  cerebral  arteries  (1874),  the 
articles  on  syphilis  oft  he  brain  and  cord  and  dysentery  in  Ziemmsen’s 
Handbuch  (1873-74),  a prize  essay  on  experimental  diphtheria  (1883), 
essays  on  cerebral  meningitis  (1886),  scarlatinal  diphtheria  (1888), 
infant  nutrition  and  children’s  hospitals  (1879),  chronic  nephritis  and 


Fig.  36. — Johann  Otto  Leonhardt  Fig.  37. — Adalbert  Czerny  (1863— 

Heubner  (1843-  ).  (Courtesy  of  ).  (Courtesy  of  Dr.  Henry  F. 

Dr.  J.  H.  Hess,  Chicago.)  Helmholz,  Chicago.) 

albuminuria  in  children  (1891),  treatment  of  disorders  of  infant  nutri- 
tion (1894),  syphilis  in  children  (1896),  the  metabolism  of  a boy  (1902) 
a splendid  treatise  on  pediatrics,  based  upon  his  own  clinical  findings, 
(1903-6,  3.  ed.,  1911),  a valuable  history  of  the  pediatrics  of  infancy 
(1909)  and  a volume  of  pediatric  essays  (1912).  In  1894,  Heubner 
built,  with  his  own  hands,  the  first  successful  respiration  calorimeter. 
In  1898-9,  appeared  the  classic  monographs  of  Max  Rubner  and  Heub- 
ner on  the  average  daily  food  (energy)  requirements  of  the  normal  and 
atrophic  infant,*  which  have  remained  the  basis  of  all  subsequent 
metabolism  experiments  on  infant  feeding.  He  inaugurated  the 
method  of  caloric  feeding.  In  1901  he  introduced  the  concept  of  the 
“energy  quotient,”!  f-e.,  the  number  of  large  calories  per  kilogram  of 
body  weight  per  diem  necessary  for  infant  growth.  In  1911,  he  intro- 
duced his  theory  of  “digestion  insufficiency.”  He  made  Barlow’s 
disease  known  in  Germany.  Heubner  is  a distinct  leader  of  modern 

* Rubner  and  Heubner,  Ztschr.  f.  Biol.,  Munich,  xxxvi  (1898),  p.  1;  xxxviii 
(1899),  p.  315. 

t Heubner,  Ztschr.  f.  dial.  u.  phys.  Therap.,  Leipzig,  v (1901-2),  pp.  13-35. 


136 


HISTORY  OF  PEDIATRICS 


pediatric  thought  and  an  influential  teacher,  numbering  among  his 
pupils  Finkelstein,  Langstein,  Stoeltzner  and  Salge.  Heubner  is 
described  by  Finkelstein  as  “nothing  of  the  pompous,  prepense 
Olympian  of  calculated  sublimity  and  pathetic  stage  gestures,  but  a 
genuine,  whole-hearted  human  man,  full  of  life,  movement,  fire, 
natural,  original  and  impulsive  in  every  fibre  of  his  being.”  In  old 
age,  he  was  not  “the  ossified,  myopic  discourager  of  youth,”  but  carried 
the  younger  men  along  with  him  by  the  youthful  freshness  and  charm 
of  his  own  personality. 

Adalbert  Czerny  (1863-  ),  of  Szczakowa,  Galicia,  a pupil  of 

Epstein,  graduated  M.D.  at  Prague  (1888),  and  succeeded  Soltmann 
as  professor  extraordinarius  at  Breslau  (1894),  where  he  founded  a 
Pediatric  Clinic  and  Polyclinic.  In  1906,  he  became  full  professor, 
and  in  1910,  professor  at  Strassburg,  and  succeeded  Heubner  in  Berlin 
in  1913.  He  published  a histological  study  of  degenerative  processes 
in  the  liver  (1890),  lectures  on  the  physician  as  educator  of  the  child 
(1908,  3.  ed.,  1911)  and  with  A.  Keller,  a great  treatise  on  the  nutrition 
and  nutritive  disorders  of  childhood  and  their  treatment  (1906).* 
In  1893,  he  studied  the  duration  of  gastric  digestion.  In  1906,  he 
studied,  with  Keller,  the  change  in  the  composition  of  maternal  milk 
when  the  breasts  are  not  emptied,  the  harmfulness  of  fat  and  the  prov- 
enance of  fecal  fat,  and  made,  with  Steinitz,  a collective  investigation  of 
the  nitrogen  metabolism  of  infants.  In  1906-8,  he  introduced  his 
concept  of  an  “exudative  diathesis”  and  the  exanthems  produced  by 
ingestion  of  fat  in  this  condition,  which  was  confirmed  experimentally 
by  Steinitz  and  Weigert  in  1910.  Czerny  also  introduced  the  idea  of 
long  pauses  in  feeding  the  baby,  and  has  created  an  individual  school 
of  pediatric  thought  by  leading  physicians  away  from  exclusive 
contemplation  of  the  infantile  intestine  and  its  contents  to  the  inter- 
mediary processes  of  metabolism. 

Heinrich  Finkelstein  (1865-  ),  of  Leipzig,  graduated  in  philos- 

ophy (1888)  and  medicine  (1893)  at  Berlin,  became  assistant  at  the 
pediatric  clinic  in  the  Charite  (1894),  and  is  now  professor  in  the 
University  (1913),  and  is  head  physician  to  the  Orphan  Asylum  and 
the  Children’s  Asylum.  In  1902,  he  published  an  essay  on  infantile 
diseases  due  to  trauma,  in  1904,  with  L.  Ballin,  a monograph  on  the 
nursling-foundlings  of  Berlin  and  their  institutional  care,  in  1905—12 
a two-volume  treatise  on  diseases  of  nurslings,  in  1906-10,  a series  of 
papers  setting  forth  his  theory  of  sugar  and  salt  intoxication  (alimen- 
tary fever)  f with  the  introduction  of  albumin  milk  (Eiweissmilch) , a 
mode  of  starvation  feeding,  which  is  employed  until  the  intestinal 
disorder  is  relieved.  Finkelstein’s  initial  theory  that  sugars  are  harm- 
ful (1906)  has  been  modified  by  him  to  the  effect  that  fat  is  only 

* Czerny  and  Keller,  “ Des  Kindes  Ernahrung,  Ernakrungsstorungen  und 
Ernahrungstherapie.”  Leipzig  and  Wien  (1906). 

t Finkelstein,  'Verhandl.  d.  Gesellseh.  f.  Kinderheilk.,  Stuttgart,  xxiii  (1906), 
p.  117.  Jahrb.  f.  Kinderheilk.,  lxv  (1907),  pp.  1,  263;  lxviii  (190S),  p.  521;  lxxi. 
(1910),  p.  525. 


INFANT  METABOLISM  AND  INFANT  NUTRITION 


137 


harmful  when  the  intestines  are  irritated  by  carbohydrate  fermentation 
(1910).  In  1911,  appeared  his  Arbeiten  from  the  Berlin  Children’s 
Asylum'.  Finkelstein,  a man  of  broad  philosophical  education,  is 
described  as  a keen,  close  observer  and  most  remarkable  clinician  of 
the  analytic  type.  Like  several  other  eminent  physicians,  he  early 
made  his  mark  in  geology  (Abt). 

Arthur  Schlossmann  (1867-  ),  of  Dresden,  who  was  simul- 

taneously director  of  the  Pediatric  Polyclinic  and  Infant’s  Home  at 
Dresden,  and,  in  1906,  became  professor  and  director  of  the  Children’s 
Clinic  at  Diisseldorf,  has  written  on  rickets  (1891),  diphtheria  (1894), 


Fig.  38. — Heinrich  Finkelstein  Fig.  39. — Arthur  Schlossmann 

(1865-  ).  (Courtesy  of  Dr.  (1867—  ).  (Courtesy  of  Dr.  J. 

Isaac  A.  Abt,  Chicago.)  H.  Hess,  Chicago.) 

the  differences  between  human  and  cow’s  milk  (1898),  and  the  com- 
position of  human  milk  (1900-1902),  poisons  and  tuberculosis  (1906), 
the  care  of  infants  in  the  first  two  years  of  life  (1907),  and  stall  hygiene 
(1909).  He  did  most  for  the  organization  of  infant  hygiene  on  a grand 
scale.  In  1908,  he  showed  that  the  saliva  of  the  newborn  converts 
starch  into  sugar  as  soon  as  secreted.  With  H.  Murschhauser,  he 
showed  the  marked  influence  of  muscular  activity  on  heat  production 
in  the  attempt  to  ascertain  the  basal  metabolism  of  the  infant  (1908- 
14);*  and  investigated  the  fasting  metabolism  of  infants,  showing  the 
pathological  appearance  of  acetone  in  the  urine,  after  18  hours  fast, 
from  the  privation  of  food  carbohydrates  (1913).  He  collaborated  with 
M.  von  Pfaundler  in  a pediatric  Handbuch,  on  the  co-operative  plan 

* Schlossmann  and  Murschhauser,  Biochem.  Ztschr.,  Berlin,  xiv  (1908), 
p.  369;  xxvi  (1910),  p.  14;  liii  (1913),  p.  265;  lvi,  p.  355;  Ivin  (1914),  p.  483. 


138 


HISTORY  OF  PEDIATRICS 


(1906,  2d  ed.,  1910-12),  which  was  translated  into  English  under  the 
editorship  of  Henry  L.  K.  Shaw  and  Linnaeus  E.  La  Fetra  (1908,  2. 
ed.,  1912).  Schlossmann  is  co-editor  of  the  Archivfur  Kinderheilkunde 
(1902),  and  the  Zeitschrift  fur  S auglingsfursorge  (1910). 

Meinhard  von  Pfaundler  (1872-  ) director  of  the  University 

Pediatric  Clinic  at  Munich,  investigated  the  anatomy  of  the  suprarenal 

glands  (1892),  the  gastric  capacity 
of  infancy  and  childhood  (1898), 
spinal  puncture  in  children  (1899), 
calcium  absorption  in  rickets 
(1904,)  and,  with  E.  Moro,  demon- 
strated that  hemolysin  is  a normal 
constituentof  different  milks  (1907.) 
He  collaborated  with  Schlossmann 
in  the  above-mentioned  Handbuch 
der  Kinder krankheiten  (1906).  His 
pediatric  clinic  at  Munich  is  one 
of  the  best  on  the  continent. 

Arthur  Keller  (1868-  ), 

Czerny’s  assistant,  has  written  on 
the  care  of  illegitimate  infants  (with 
H.  Reicher,  1909),  infant  nutrition 
(1901),  infant  welfare  and  child- 
protection  in  England,  Scotland  and 
Hungary  (1911)  and  collaborated 
with  Czerny  in  his  massive  treatise 
on  infant  nutrition  (1906).  He 
showed  that  breast-fed  infants 
retain  more  (or  excrete  less)  phos- 
phorus than  the  bottle-fed,  which 
was  confirmed  by  L.  F.  Meyer  (1908)  and  by  Knox  and  Tracy  (1914). 
He  also  showed  that  carbohydrates  make  protein  digestion  more 
complete.  In  1912,  he  edited  (with  Chr.  J.  Klumker),  a collaborative 
history  of  infant  welfare  and  child-protection  in  Europe  by  many 
hands. 

Leo  Langstein,  private-docent  in  pediatrics  at  the  University  of 
Berlin,  graduated  at  Leipzig  with  a dissertation  on  albuminuria  in 
older  children  (1897)  and  collaborated  with  L.  F.  Meyer  in  a sterling 
work  on  infant  nutrition  and  metabolism  (1910),*  the  clearest,  most 
compact  and  most  intelligible  of  all  modern  books  on  this  subject. 
He  investigated  erepsin  in  the  fetus  (with  Soldin,  1908)  and  showed 
(with  Steinitz)  the  presence  of  lactose  in  all  stools  of  enteritis  (1909). 

Ludwig  F.  Meyer,  Finkelstein’s  pupil  and  privat-docent  at  Berlin, 
collaborated  with  Langstein  in  the  above  mentioned  work  on  infant 
nutrition  (1910),  showed  the  retention  of  nitrogen  for  tissue-building 
in  fasting  infants  and  as  the  amount  of  protein  in  food  is  increased 

* Langstein  and  Mayer,  “Sauglingsernahrung  und  Sauglingsstoffwechsel.” 
Wiesbaden  (1910). 


Fig.  40. — Meinhard  von  Pfaundler 
(1872-  ).  (Courtesy  of  Dr.  J.  H. 

Hess,  Chicago.) 


INFANT  METABOLISM  AND  INFANT  NUTRITION  139 

(1908),  investigated  infantile  atrophy  under  different  conditions  and 
with  different  foods  (1910)  and  showed  that  normal  babies  are  able  to 
digest  fats,  since  there  is  no  loss  of  fat  or  salts  when  fats  in  the  food  are 
increased  (1910).  Langstein  and  Meyer  also  did  important  work  on 
alcaptonuria  and  the  effect  of  sugar  on  infant  nutrition. 

Hermann  Pruning  (1874-  ),  professor  extraordinarius  of 

pediatrics  at  Rostock,  where  he  habilitated  with  a dissertation  on  infant 
nutrition  (1906),  is  the  author  of  a history  of  artificial  nutrition  of 
infants  (1908),  a study  of  infant  mortality  in  Mecklenburg-Schwerin 
(1909),  and  edited  with  E.  Schwalbe,  a collaborative  Handbook  of  the 
General  Pathology  and  Pathological  Anatomy  of  Childhood  (1912). 

Emil  Feer  (1864-  ),  of  Aarau,  Switzerland,  settled  as  pediatrist 

in  Basel  (1892),  became  professor  extraordinarius  and  director  of  the 
Pediatric  Clinic  at  Heidelberg  (1907)  and  later  professor  of  pediatrics 
and  director  of  the  University  Pediatric  Clinic  at  Zurich  (1911). 
He  wrote  on  the  power  of  heredity  (1905),  diseases  of  the  air-passages 
and  respiratory  organs  in  infancy  (1906),  the  influence  of  consanguinity 
of  the  parents  on  the  child  (1907).  In  1896,  he  showed  that  the 
nursling  gets  one-half  its  meal  in  the  first  five  minutes  of  suckling  and 
more  than  one-quarter  in  the  next  five  minutes.  In  1910,  he  published 
a concise  and  comprehensive  Lehrbuch  der  Kinderheilkunde,  containing 
contributions  on  infantile  diseases  and  digestive  disorders  by  Finkel- 
stein,  blood  and  diathetic  diseases  by  Pfaundler,  diseases  of  the 
air- passages  and  tuberculosis  by  Pirquet,  diseases  of  the  heart  and  infec- 
tious diseases  by  Feer,  diseases  of  the  genito-urinary  organs  by  Tobler, 
diseases  of  the  nervous  system  by  Ibrahim,  syphilis  and  cutaneous 
diseases  by  Moro.  This  became  so  popular  that  it  reached  its  third 
edition  in  1914. 

Ludwig  Tobler  (1877-1915)  of  Zurich,  graduated  at  Zurich  (1902), 
became  assistant  in  the  pediatric  clinic  (1905)  and  professor  extra- 
ordinarius (1911)  at  Heidelberg  and  later  professor  and  director  of 
the  University  Clinic  at  Breslau  (1911).  He  investigated  the  axillary 
arch  in  man  as  a vestige  of  the  mammalian  panniculus  carnosus  (1902), 
studied  the  mechanism  of  gastric  digestion  (1905-6),  the  coagulation- 
time  for  casein  in  the  stomach  (1906),  the  duration  of  gastric  digestion 
in  infancy,  using  the  X-ray  (1908),  and  showed  that  fats  delay  the 
emptying  of  the  stomach  and  that  large  amounts  of  fats  cause  pyloric 
spasm  (1907).  With  Noll,  he  studied  the  calcium  metabolism  in 
infants  (1910)  and  collaborated  with  Bessau  in  a work  on  the  patho- 
logical physiology  of  nutrition  and  metabolism  in  children  (1914).* 

Yussuf  Ibrahim,  director  of  the  Hamidie  Hospital,  founded  by 
Sultan  Abdul  Hamid  II  at  Constantinople  in  1898,  and  latterly  of  the 
Gisela  Children’s  Hospital  at  Munich,  habilitated  at  Heidelberg  with  a 
dissertation  on  congenital  stenosis  (1905),  wrote  on  rheumatism  (1906) 
and  nervous  diseases  (1911)  in  children,  and  in  1908  made  an  important 
contribution  on  the  digestive  ferments  in  the  stomach,  pancreas  and 

* Tobler  and  Bessau,  “Allgemeine  pathologisehe  Phvsiologie  der  Ernahrung 
und  aes  Stoffwechsels  im  Kindesalter.”  Wiesbaden  (1914). 


140 


HISTORY  OF  PEDIATRICS 


intestines  of  the  newborn  infant.  * He  was  the  first  to  find  enterokinase 
in  the  intestinal  mucous  membrane  of  the  newborn  (1908). 

Franz  von  Soxhlet  (1848-1907),  of  Briinn,  Moravia,  professor  of 
agricultural  chemistry  in  the  Technical  High-School  at  Munich,  has 
written  on  the  physical  chemistry  of  milk  (1872),  the  nature  of  milk 
droplets  (1876),  metabolism  of  the  calf  (1878),  fat  formation  from 
carbohydrates  (1882),  the  chemical  differences  between  human  and 
cow’s  milk  (1893)  and  devised  a method  for  estimating  the  fat-content 
of  milk  (1881)  and  the  well-known  method  and  apparatus  for  sterilizing 
infant’s  milk  (1886). f Other  valuable  studies  of  milk  have  been  made 
by  C.  0.  Jensen  (1903),  Milton  J.  Rosenau  (1908-12),  K.  Winslow 
(1909),  Paul  Sommerfeld  ( Handbuch  der  Milchkunde,  1909)  and  Janet 
E.  Lane-Claypon  (1912-13). 

In  France,  Pierre-Constant  Budin  (1846-1907),  of  Paris,  who 
succeeded  Tarnier  as  professor  of  obstetrics  on  the  Paris  Faculty  (1898), 
has  written  on  the  sterilization  of  milk  (1892),  on  lying-in  women  and 
the  newborn  infant  (1897),  a Manual  pratique  de  Vallaitement  (1905, 

2.  ed.,  1907),  and  a comprehensive  treatise  on  the  nursling  ( Le  Nourris- 
son,  1900),  which  has  been  translated  into  English  (1907),  and  is 
frequently  drawn  upon  as  a storehouse  of  interesting  facts. 

Henri  de  Rothschild  (1872-  ),  head  physician  of  the  Polyclinic 

H.  de  Rothschild  and  director  of  the  Revue  d’hygiene  et  de  patholoqie 
infantile  (1902),  has  written  on  sterilized  milk  in  infant  nutrition 
(1897),  the  hygiene  and  protection  of  childhood  in  Europe  (1897), 
gastro-intestinal  troubles  in  infancy  (1898,  1904),  U allaitement  mixte  et 
Vallaitement  artificial  (1898),  the  hygiene  of  milk  feeding  (1899),  the 
milk-industry  (1903-4),  has  prepared  an  exhaustive  and  valuable 
bibliography  of  milk  ( Bibliotheca  lactaria,  1901-2),  and  has  edited  a 
massive  and  sumptuous  treatise  on  the  hygiene  and  pathology  of 
infancy,  by  various  authors  (1905).  Rothschild  is  a sportsman, 
playwright  and  philanthropist-physician,  whose  activities  in  securing 
milk-depots  for  the  poor  of  Paris  are  comparable  with  those  of  Nathan 
Straus  in  New  York  (1890).  He  was  one  of  the  first  to  found  a “Nurs- 
ling’s Consultation”  or  “Mother’s  Home”  in  Paris,  which  soon 
outgrew  its  modest  home  in  the  rue  Picpus  and,  in  December,  1902, 
acquired  a splendid  building  in  the  rue  Mercadet.  In  1905  a brilliant 
banquet  was  given  in  his  honor,  at  which  his  former  teachers,  Dieula- 
foy,  Budin,  Poirier,  responded  in  terms  of  cordial  praise,  t 

Luigi  Concetti  (1854-1920),  of  Rome,  a very  active  teacher,  wrote 
much  on  pediatric  instruction  (1895-1911),  and  a treatise  on  infant 
hygiene  (1903).  Francesco  Fede  (1832-1913),  editor  of  La  Pediatria 
(1893),  described  the  sublingual  tumor  ( produzione  sottolinguale ) to 
which  Riga  of  Naples  drew  attention  in  1881  (Riga’s  disease). 

* Ibrahim,  Verhandl.  d.  Versamml.  d.  Gesellsch.  f.  Kinderheilk.,  deutscli. 
Naturf.  u.  Aerzte  (1908),  Wiesbaden,  xxv  (1909),  pp.  21—42. 

t Soxhlet:  Munchen  med.  Wochenschr.,  xxxiii  (1886),  pp.  253,  276. 

t Hommage  au  Dr.  Henri  de  Rothschild.  Progres  med.,  Paris,  xxi  (19051, 

3.  s.,  pp.  371-376. 


INFANT  METABOLISM  AND  INFANT  NUTRITION 


141 


In  Russia,  much  work  has  been  done  on  the  physiology  of  infantile  digestion 
in  “The  Peculiarities  of  Childhood  ’ by  N.  P.  Gundobin  (1912)  and  the  papers  and 
students’  theses  of  Glinsky  (1895),  Sotoff  (1895),  Wulfson  (1898),  Geptner  (1900), 
Harge  (1900)  Debele  (1901),  Kovalski  (1900),  Snarsky  (1901),  Borisoff  (1903), 
Heymann  (1904),  Sellheim  (1904),  and  others  (Morse  and  Talbot). 

Thomas  Morgan  Rotch  (1849-1914),  of  Philadelphia,  a medical 
graduate  of  Harvard  (1874),  eventually  held  the  first  professorship  of 
pediatrics  in  that  University  (1888).  He  did  much  to  give  pediatrics  a 
definite  place  in  the  medical  curriculum,  established  the  Infant’s 


Hospital  and  the  first  milk  laboratory  (Walker-Gordon,  1891)  in 
Boston,  wrote  an  important  pediatric  treatise  (1896)  and  was  the 
pioneer  of  the  clean  milk  idea  in  America.  His  Walker-Gordon 
laboratory  was  soon  followed  by  similar  aseptic  establishments 
in  London  and  elsewhere.  He  introduced  the  method  of  percentage  or 
substitute  feeding  of  infants  (1896)  in  which  fats,  carbohydrates  and 
sugar  were  given  in  dosage  approximate  to  the  needs  of  different  babies. 
The  doctrine  of  proteins,  upon  which  the  advocates  of  percentage 
feeding  relied,  was  contravened  by  the  purposeful  Eiweissmilch  of 
Finkelstein,  which  (as  although  nearly  free  from  lactose)  was  again 
evolved  from  the  equally  dubious  doctrine  of  the  indigestibility  of 
sugars.  Rotch  also  did  some  important  work  on  pericarditis  and 
pericardial  punctures;  and,  toward  the  end  of  his  life,  made  some 
researches  on  the  physiological  age  of  children,  using  X-ray  pictures  of 
the  small  bones  of  the  wrist  as  a basis  for  an  anatomical  index  of  growth 
in  relation  to  the  "somatic”  as  opposed  to  the  "chronological”  age  of 
the  child  (1907-10).* 

*For  a good  account  of  Rotch’s  work,  see  A.  Jacobi,  Am.  Jour.  Dis.  Child., 
Chicago,  viii  (1914),  pp.  245-249. 


142 


HISTORY  OF  PEDIATRICS 


Luther  Emmet  Holt  (1855),  of  Webster,  N.  Y.,  a graduate  of 
the  College  of  Physicians  and  Surgeons,  New  York,  and  professor  of 
diseases  of  children  in  the  New  York  Polyclinic  (1890)  and  the  College 
of  Physicians  and  Surgeons  (1902),  is  an  acknowledged  leader  of  pedia- 
trics in  this  country,  a strong  executive  and  an  able  teacher  and 
writer.  He  is  the  author  of  treatises  on  the  Care  and  Feeding  of 
Children  (1894,  8th  ed.,  1915)  and  the  Diseases  of  Infancy  and 
Childhood  (1896,  7th  ed.,  1916)  and  a large  number  of  minor  contribu- 
tions. He  has  been  a principal  advocate  of  home  modifications  of  milk 
and  pasteurized  milk.  In  the  laboratory  study  of  infant  metabolism, 


Fig.  43. — Henry  Dwight  Chapin  Fig.  44. — Isaac  Arthur  Abt 

(1857-  ).  (1867-  ). 


he  has  worked  with  P.  A.  Levene,  Angela  M.  Courtney,  D.  D.  Yan 
Slyke  and  Helen  L.  Fales  on  the  effect  of  high  protein  feeding  (1912), 
casein  feeding  (1913),  the  chemical  composition  of  diarrheal  stools 
(1915),  the  excretion  of  magnesium  sulphate  (1915),  human  milk 
(1915)  cod-liver  oil  in  infantilism  (1917)  and  fatty  metabolism  in 
infants  (1919).  Holt  has  also  written  a suggestive  historical  study 
of  infant  mortality  (1913),  and,  with  Miss  Ellen  C.  Babbitt,  a valuable 
statistical  analysis  of  institutional  mortality  in  the  new-born,  based 
upon  10,000  consecutive  births(1915). 

Henry  Leber  Coit  (1854-1917),  of  Peapack,  New  Jersey,  a graduate 
of  the  College  of  Physicians  and  Surgeons,  New  York  (1883),  was  the 
originator  of  the  certified  milk  movement  in  the  United  States,  which 
he  worked  out  in  a dairy  plant  near  Newark  in  the  first  instance.  He 
also  organized  an  infant’s  hospital  at  Newark. 

Henry  Dwight  Chapin  (1857-  ),  of  Steubenville,  Ohio,  a grad- 

uate of  the  College  of  Physicians  and  Surgeons,  New  York  (1881), 
professor  of  pediatrics  in  the  New  York  Post  Graduate  Medical  School 


INFANT  METABOLISM  AND  INFANT  NUTRITION 


143 


and  Hospital,  was,  with  Jacobi,  the  principal  advocate  of  standardized 
cereal  gruels  in  infant  feeding.  He  has  studied  the  biological  aspects 
of  different 'milks,  invented  the  Chapin  milk-dipper,  and  is  the  author 
of  a “Theory  and  Practice  of  Infant  Feeding” ' (1902,  3d  ed.,  1909), 
Vital  Questions  (1909),  and,  with  Godfrey  Roger  Pisek  (1875-1921), 
of  New  York,  a Treatise  on  Diseases  of  Children  (1909,  4th  ed.,  1919). 
He  has  also  written  on  the  function  of  maternal  milk  in  developing  the 
stomach  (1903),  proteid  incapacity  in  infant  and  child  (1907),  acidosis 
of  intestinal  origin  (1916)  and  established  the  distinction  between  the 
gross  caloric  value  of  a food  and  its  net  caloric  value,  he.,  the  energy 
required  for  its  digestion  and  assimilation  (1913).  Chapin  has  done 
much  in  humanitarium  work  for  the  homeless  infants  of  the  poor  in 
New  York  City. 

Isaac  Arthur  Abt  (1867-  ),  of  Wilmington,  Illinois,  a graduate 

of  the  Johns  Hopkins  University  (1889)  and  of  the  Chicago  Medical 
College,  Chicago  (1891),  was  interne  of  Michael  Reese  Hospital  (1891- 
3),  did  post-graduate  work  in  Vienna  and  Berlin  (1893-94),  and  has 
been  professor  of  pediatrics  in  the  Northwestern  University,  Woman’s 
Medical  School  (1909),  Rush  Medical  College  and  the  Michael  Reese, 
Cook  County  and  other  Chicago  hospitals.  As  the  leading  pediatrist 
in  the  West,  he  is  widely  known  as  a teacher,  writer  and  editor.  He  is 
the  author  of  “The  Baby’s  Food”  (1917),  and  editor  of  the  pediatric 
volumes  in  the  Practical  Medicine  Series  (1906-21). 

He  has  made  a large  number  of  investigations,  notably  of  floating  kidneys 
in  children  (1901),  acute  non-suppurative  encephalitis  (1906),  rachitic  erosions 
of  permanent  teeth  as  a result  of  infantile  diseases  (with  Mortimer  Frank,  1908), 
status  of  the  kindergarten  (1908),  irritating  effects  of  cathartic  drugs  in  infants 
(1909),  traumatic  diabetes  (1911),  “starch-injuries”  (1913),  unusual  types  of  acid 
intoxication  (1914),  226  cases  of  chorea  (1916),  familial  icterus  in  newborn  infants 
(1916).  He  has  also  written  an  interesting  history  of  the  classification  of  gastro- 
intestinal diseases  (1912). 

John  Howland  (1873-  ),  of  New  York,  a graduate  of  University 

Medical  College,  New  York  (1897),  and  professor  of  pediatrics  in  the 
Medical  Schools  of  Washington  University,  St.  Louis,  (1911)  and  the 
Johns  Hopkins  University  (1912),  has  been  a pioneer  in  American  work 
on  the  fundamental  requirements  of  infant  nutrition.  In  1910-11,  he 
studied  the  chemical  and  energy  metabolism  of  sleeping  children, 
substituting  direct  calorimetry  for  computations  from  heat-measure- 
ment, and  in  1913,  he  devised  a formula  for  estimating  the  area  of  body 
surface  in  connection  with  infant  metabolism.  He  assisted  Holt  in  the 
sixth  and  seventh  editions  of  his  pediatric  treatise  (1911,  1919,)  and 
with  his  talented  associate,  William  McKim  Marriott  (1885-  ),  has 

made  important  studies  on  acidosis  and  acetone-body  production  in 
children’s  diseases  (1916)  and  the  calcium  content  of  the  blood  in 
rachitis  and  tetany  (1916).  Marriott  has  devised  methods  for  deter- 
mining the  alkali  content  of  the  blood  plasm  (1916)  and  the  alveolar 
carbon  dioxide  (1916). 

John  Lovett  Morse  (1865-  ),  of  Taunton,  Mass.,  a graduate  of 


144 


HISTORY  OF  PEDIATRICS 


Harvard  (1887),  and  of  Harvard  Medical  School  (1891),  practised  in 
Boston  (1892)  and  became  instructor  in  pediatrics  in  Harvard  Medical 
School  (1903-6),  assistant  professor  (1906-15)  and  professor  (1915). 
An  unsurpassed  clinician,  he  has  written  a great  number  ol  papers  from 
his  large  experience,  culminating  in  his  Case  Histories  in  Pediatrics 
(1911,  2d  ed.,  1913),  in  which  the  subject  is  taught  inductively  by  the 


Fig.  45. — John  Howland  (1873—  ). 


Fig.  46. — John  Lovett  Morse 
(1865-  ). 


synthetic  method.  He  is  also  the  author  of  the  Care  and  Feeding  of 
Children  (1914),  and  of  studies  on  the  overheating  of  food  as  a cause  of 
scurvy  (1906-14)  and  on  casein  dyspepsia  (1913);  and  has  collaborated 
with  Fritz  Talbot  in  the  Diseases  of  Nutrition  and  Infant  Feeding 
(1915,  2d  ed.,  1920),  a book  in  which  the  history  of  the  subject  is  deftly 
interwoven,  with  valuable  footnotes,  as  in  Schaefer’s  Physiology. 

Fritz  Bradley  Talbot  (1878-  ),  of  Boston,  a graduate  of  Harvard 

(1900)  and  Harvard  Medical  School  (1905),  after  clinical  experience  in 
the  Children’s  Hospital,  Boston  (1905)  and  the  Massachusetts  General 
Hospital  (1905-7),  was  Morse’s  assistant  for  three  years,  at  the  same 
time  doing  work  in  biological  chemistry  at  Harvard.  He  is  now 
instructor  in  pediatrics  in  the  Harvard  Medical  School,  was  visiting 
physician  to  the  Boston  Floating  Hospital  (1909-14)  and  since  1909 
has  been  chief  of  the  Children’s  Medical  Department  at  the  Massa- 
chusetts General  Hospital.  Well-grounded  in  the  best  type  of  Amer- 
rican  training,  Talbot  has  attacked  some  difficult  problems.  In  1909-10, 
he  investigated  the  large  and  small  curds  in  infants’  stools,  showing, 
by  serologic  methods,  that  the  large  bean  shaped  curds,  originally  exam- 
ined by  Biedert  (1888),  are  composed  of  casein,  the  small  soft  curds, 
examined  by  Uffelmann  (1881),  Fr.  Muller  (1884),  Escherich  (1888), 


INFANT  METABOLISM  AND  INFANT  NUTRITION 


145 


ing  made  of  fatty  acids  or  soaps.  In  1912,  he  began  his  studies  on 
e gaseous  interchange  and  general  metabolism  of  infants  with 
•ancis  Gano  Benedict  (1870-  ),  of  Milwaukee,  director  of  the 

utrition  Laboratory  of  the  Carnegie  Institution  of  Washington, 
suiting  in  two  monographs  on  the  Gaseous  Metabolism  of  Infants 
914)  and  the  Physiology  of  the  New-born  Infant  (1915).  Talbot 
s also  investigated  the  effect  of  lactose  on  nitrogen  metabolism 


Fig.  47. — Fritz  Bradley  Talbot  Fig.  48.— John  Ruhrah  (1872-  ). 

(1878-  ). 


ith  L.  Hill,  1914),  the  energy  metabolism  of  the  decerebrate  infant 
915)  and  the  cretin  (1916-18),  the  protein  metabolism  of  infants  (with 
L.  Gamble,  1916),  and  the  relation  of  asthma  in  children  to  ana- 
ylaxis  (1914-16).  He  collaborated  with  Morse  in  the  book  on 
ant  nutrition  above  mentioned  (1915,  2d  ed.,  1920). 

John  Ruhrah  (1872-  ),  of  Chillicothe,  Ohio,  a graduate  of  the 

College  of  Physicians  and  Surgeons  (Baltimore,  1894),  did  post- 
iduate  work  at  the  Johns  Hopkins,  the  Pasteur  Institute,  Paris 
397)  and  in  other  European  schools  (1900-1901),  was  quarantine 
, ysician  of  the  port  of  Baltimore  (1898-1900),  where  he  is  now  profes- 
’ of  pediatrics  in  the  University  of  Maryland  Medical  School  and  in 
he  College  of  Physicians  and  Surgeons.  He  made  the  first  collective 
. mstigation  of  actinomycosis  in  the  United  States  (1899-1900), 
roduced  the  soy  bean  in  infant  dietetics  (1909),  and  is  the  author 
a useful  manual  of  the  Diseases  of  Infants  and  Children  (1905, 

i i ed.,  1914)  with  Julius  Friedenwald,  Diet  in  Health  and  Disease 
( I 905,  5th  ed.,  1919)  and  Dietetics  for  Nurses  (1905,  4th  eel.,  1917)  and, 

th  Erwin  F.  Mayer,  a treatise  on  “Poliomyelitis  in  all  its  aspects” 
917).  He  has  been  active  in  medical  library  work,  was  instrumental 

ii  the  erection  of  the  new  Library  building  of  the  Medical  and  Chirur- 

Vol.  I — 10 


146 


HISTORY  OF  PEDIATRICS 


gical  Faculty  of  Maryland  and  is  editor  of  the  Bulletin  of  the  Medical 
Library  Association  (1911). 

Bert  Raymond  Hoobler  (1872-  ),  professor  of  pediatrics  in  the 

Detroit  College  of  Medicine  and  Surgery,  has  done  important  work  on 
the  retention  of  mineral  salts  in  infant  metabolism  (1911),  the  effect 
of  protein  diet  on  the  product  of  human  milk  (1917),  and  is  the  deviser 
of  an  adjustable  metabolism  bed  (1912)  and  a device  for  standardizing 
blood-pressure  readings  (1912).  He  also  investigated  the  metabolism 
of  ten  hospital  infants  and  devised  a respiration  incubator  for  the 
energy  metabolism  of  infants  (1915)  with  John  R.  Murlin  (1874—  ), 

who  has  also  studied  the  metabolism  of  development  (1910)  and  the 
metabolism  of  mother  and  child  just  before  and  after  birth  (with 
Carpenter,  1911). 

Alfred  Fabian  Hess  (1875-  ),  clinical  professor  of  pediatrics  in 

the  University  and  Bellevue  Hospital  Medical  College,  devised  a 
duodenal  tube  and  catheter  (1911-12)  and  investigated  infantile 
jaundice  (1912),  allergy  to  common  foods  (1912),  the  leucocyte  count  in 
pneumonia  and  meningitis  (1914),  pylorospasm  and  allied  spasm  (1914), 
gastric  exploration  (1914-15),  protective  therapy  for  mumps  (1915) 
and  has  recently  made  extended  studies  of  infantile  scurvy 
(1916-19),  summarized  in  his  treatise  of  1920. 

Julius  Hays  Hess  (1876-  ),  professor  of  pediatrics  in  the 

College  of  Medicine,  University  of  Illinois,  and  chief  of  the  pediatric 
staff  at  Cook  County  Hospital  (Chicago)  is  the  author  of  recent  books 
on  infant  feeding  (1918,  2nd  ed.  1919)  and  on  premature  and  con- 
genitally diseased  infants  (1921). 

Of  other  work  in  this  field,  it  is  sufficient  to  mention  that  done  in  the  Russell 
Sage  Institute  of  Pathology  by  Graham  Lusk,  Eugene  F.  Dubois,  Delafield  Dubois 
and  Frank  C.  Gephart  on  clinical  calorimetry  (1915-16),  the  method  of  estimating 
fats  devised  by  Gephart  and  F.  A.  Csonka  (1914),  the  linear  formula  of  Delafield 
Dubois  for  calculating  the  surface  area  of  the  body  (1915),  the  investigations  of 
E.  F.  Dubois  on  metabolism  in  boy-scouts  (1915—16),  the  survey  of  Lucy  H. 
Gillett  on  evidence  regarding  food  allowances  for  healthy  children  (1910)  and 
of  Gillett  and  Sherman  on  Adequacy  and  Economy  of  Some  City  Dietaries  (1917). 

Bacteriology  and  Serology 

The  work  of  Pasteur,  Koch  and  Lister  brought  about  some  striking 
improvements  in  practical  pediatrics.  The  studies  of  the  great 
Viennese  pediatrists,  Bednar  and  Ritter  von  Rittershain,  upon  the 
intestinal  toxemias  and  wouncl-infections  of  infancy  were  carried  for- 
ward into  direct  prophylaxis  by  Epstein,  who  instituted  the  most  rigid 
aseptic  procedure,  an  absolute  surgical  cleanliness,  in  the  hygienic 
management  of  the  wards  in  foundling  asylums  and  their  inmates, 
lowering  the  mortality,  during  14  years,  from  30  to  5 per  cent.  Prior 
to  this  period,  Gottfried  Eisenmann  had  suggested  the  instillation  of 
chlorine  water  to  prevent  infantile  conjunctivitis  (1830),  which  was 
neglected  until  the  obstetrician,  C.  S.  F.  Crede  (1819-61)  introduced  his 
silver  nitrate  solution  (1884).  Ignaz  Philipp  Semmelweis  (IS  18-65) 
made  himself  immortal  by  his  precautionary  measures  against  puer- 


BACTERIOLOGY  AND  SEROLOGY 


147 


peral  septicemia  (1847-61),  which  was  followed  by  the  carbolic  acid 
solution  of  Etienne  Tarnier  (1881).  Pediatrists  trained  in  technical 
chemistry,  like  Schlossmann,  took  up  the  hygiene  of  stalls  and  of  milk 
and  the  milk-supply,  so  that  infant  life  was  truly  surrounded,  in 
hospital  at  least,  by  every  aseptic  precaution.  In  1886*  Theodor 
Escherich  (1857-191  l)f  of  Munich,  a pupil  of  Gerhardt,  professor  at 
Graz  (1890,  1894)  and  Vienna  (1902),  where  he  succeeded  Widerhofer, 
published  the  first  treatise  on  the  intestinal  bacteria  of  infants,  a classic 
work  which  is  still  a monument  of  research.  It  was  based  upon  his 
new  method  of  isolating  bacteria 
in  infantile  feces  (1884).  The 
infant’s  mouth  (sterile  at  birth)  is 
infected  by  the  bacteria  from  the 
mother’s  vagina  during  labor,  and 
from  the  air,  nipples,  milk  and  other 
foods  after  birth.  Escherich  de- 
scribed the  swarming  bacterial  flora 
of  the  intestines  and  gave  the  first 
account  of  bacillus  coli  infection. 

Other  bacteria,  such  as  the  Bacil- 
lus bifidus  of  Tissier,  the  bacillus 
acidophilus  of  Moro,  the  Welch 
bacillus  and  the  peptonizing  bacillus 
of  Rodella  have  since  been  found. 

Noguchi  has  changed  the  bacillus  Fig.  49.— Theodor  Escherich  (1857- 
bifidus  into  b.  acidophilus  and  back  491 1 ) . (Courtesy  of  Dr.  J.  H.  Hess, 

again  (1910),  and  while  it  has  been  icag0'") 

difficult  to  prove  pathogenicity  of  the  infantile  strains  in  laboratory 
cultures,  Escherich,  in  1900,  described  an  epidemic  of  severe  diarrhea 
( blaue  Bacillose ) from  the  normal  acidophilic  flora  of  the  infantile 
intestine,  which,  in  the  view  of  Moro  (1905),  demonstrates  the  possi- 
bility of  endogenous  infection.  In  1900,  Escherich  advanced  the 
hypothesis  that  the  bacterial  changes  in  the  intestine,  exogamous  or 
endogamous,  may  set  up  a mild  intoxication  or  “chymus  infection,” 
an  afebrile,  acid  mucous  diarrhea  (the  ordinary  banal  gastro-enteritis), 
which  may  be  followed  by  a secondary  infectious,  toxic  gastro-enteritis, 
the  equivalent  of  the  various  dyspepsias  and  intestinal  catarrhs  of  the 
past.  In  1889,  he  tabulated  the  nutritive  requirements  of  infants  by 

age.  In  1902,  he  maintained  that  sugar  is  harmful  to  the  infant  as 
being  a culture-medium  for  the  growth  of  pathogenic  bacteria  of  the 
intestines.!  In  1892,  Paul  Ehrlich  (1854-1915)  showed  that  immunity 
is  transmitted  to  the  infant  through  the  maternal  milk;  that  artificial 
immunity  can  only  be  acquired  through  the  milk,  and  that  immunity 

* Escherich,  “Die  Darmbakterien  des  Sauglings.”  Stuttgart  (1886). 

f For  biography  of  Escherich,  see  Finkelstein,  Deutsche  med.  Wochenschr., 
Leipzig  and  Berlin,  xxxvii  (1911),  p.  604;  Pfaundler,  Miinchen  med.  Wochenschr., 
lvii  (1911),  pp.  521-523;  von  Pirquet,  Ztschr.  f.  Kinderheilk.,  Berlin,  i (1910-11), 

pp.  423-441  (with  bibliography). 

X Escherich,  Deutsche  Ivlinik,  Berlin,  vii  (1902),  p.  126. 


148 


HISTORY  OF  PEDIATRICS 


may  be  transmitted  by  milk  of  the  same  species  but  not  by  milk 
of  another  species.  Jules  Bordet,  in  1899,  showed  that  injection  of 
cow's  milk  into  other  animals  produces  a precipitin  in  the  blood  for  the 
albuminous  bodies  of  cow’s  milk,  which  it  coagulates.  August  von 
Wassermann  (1866-  ) showed  that  the  proteins  of  different 

animals  are  different,  i.e.,  that  the  blood  serum  of  animals  sensitized  to 
cow’s,  human  or  other  milks  will  precipitate  that  particular  milk  and 
no  other  (1900).  Clemens  von  Pirquet  (1874-  ),  former  professor 

of  pediatrics  in  the  Johns  Hopkins  University  and  at  Breslau  (1900), 


% 

* y 

>4 


Fig.  50. — Clemens  von  Pirquet  Fig.  51. — Julius  Parker  Sedgwick 

(1874-  ).  (1876-  ). 

and  director  of  the  University  Pediatric  Clinic  at  Vienna  (1911)  intro- 
duced the  cutaneous  reaction  to  tuberculin  (1907),  which  is  of  great  use 
in  the  diagnosis  of  infantile  tuberculosis;  developed  the  doctrine  of 
allergy  (1907-11)  and  "serum  disease”  (1905-7);  and  the  doctrine  of 
feeding  by  nems  (energy  in  1 cc.  of  milk),  estimated  by  a height  : weight 
ratio,  in  place  of  calories  (1917).  In  this  connection  the  formula  of 
George  Dreyer  for  the  relation  of  vital  capacity  to  body  weight  and 
surface  (1919)  is  important.  Pirquet’s  assistant,  B.  Schick,  dis- 
covered the  cutaneous  reaction  for  estimating  the  extent  of  antitoxin 
producing  power  in  the  blood  (1910).  Ernst  Moro  demonstrated 
the  presence  of  an  amylolytic  ferment  in  the  pancreas  of  the  new- 
born (1898),  showed  the  rapid  increase  in  starch-digesting  power  in 
the  first  week  of  life  (1898),  showed  that  the  blood  of  breast-fed  infants 
is  more  bactericidal  than  that  of  the  bottle-fed,  maintained  the  doctrine 
of  endogenous  infection  from  the  normal  bacterial  flora  of  the  infantile 
intestine  (1905-7),  introduced  the  skin  reaction  with  tuberculin  (1908) 
and  a specific  reaction  for  human  and  cow’s  milk  (1912). 


BACTERIOLOGY  AND  SEROLOGY 


149 


William  David  Booker  (1844),  of  Virginia,  clinical  professor  of 
pediatrics  in  the  Johns  Hopkins  University  (1897),  investigated 
the  bacteriology  and  pathology  of  the  summer  diarrheas  of  infants  in 
1888-96. 

Oscar  Menderson  Schloss.  (1882-  ) of  Cincinnati,  professor  of 

pediatrics  in  the  Medical  Department,  Harvard  University,  has  done 
some  remarkable  work  on  the  relation  of  the  metabolism  of  nitrogen, 
phosphorus  and  the  purin  substances  to  uric  acid  infarcts  in  the  kid- 
ney (1911-16),  on  protein  sensitization  to  eggs  and  other  food 
products  (1915),  and  the  permeability  of  the  gastro-enteric  tract  of 
infants  to  undigested  protein  (1916).  Julius  Parker  Sedgwick 
(1876-  ),  of  Wrightstown,  Wisconsin,  a graduate  of  Rush  Medical 

College,  Chicago  (1899)  and,  professor  of  pediatrics  in  the  University 
of  Minnesota  (Minneapolis)  discovered  a fat-splitting  ferment  in  the 
stomach  contents  of  the  newborn  infant  (1906),*  has  investigated 
recurrent  vomiting  (1912),  spasmophilia  in  children  (1912-16), 
oxalic  acid  excretion  in  the  urine  of  children  (1915),  the  uric  acid 
content  of  the  blood  in  the  newborn  (1917)  and  has  shown  (with 
W.  P.  Larson)  that  the  complement-fixation  test  with  the  bacillus 
abortus  is  present  in  the  blood  of  women  who  have  aborted  and  in 
the  blood  of  many  children  (19 13-15). f William  Palmer  Lucas 
(1882-  ),  professor  of  pediatrics  in  the  University  of  California 

Medical  School,  San  Francisco,  has  studied  the  cytology  of  meningitis 
(1911),  rheumatic  endocarditis  in  infants  (1914),  the  blood  picture  in 
the  diagnosis  of  measles  (1914)  and  has  made  a special  study  of  the 
delinquent  child.  David  Murray  Cowie  (1872-  ),  professor  of 

pediatrics  in  the  University  of  Michigan  Medical  School  (Ann  Arbor) 
has  studied  the  serum  disease  (1914)  and  the  intradermal  reaction  to 
diphtheritic  antitoxin  (1916);  and  Borden  Smith  Veeder  (1883-  ), 

associate  professor  of  pediatrics  in  the  Washington  University  Medical 
School  (St.  Louis)  has  investigated  the  metabolism  of  infants  (with 
C.  A.  Fife,  1911),  the  bacteriology  of  the  intestinal  diseases  of  infancy 
(1912)  and,  with  M.  R.  Johnston,  the  frequency  of  infection  with  the 
tubercle  bacillus  (1915),  the  chemistry  of  urine  (1916)  and  the  creatin 
and  creatinin  content  of  the  blood  (1916). 

Kenneth  Daniel  Blackfan  (1883-  ) has  investigated  the  skin  reaction  from 

proteins  in  eczema  (1916),  and,  with  Walter  E.  Dandy,  the  pathology  of  internal 
hydrocephalus  (1914-17).  Mathias  Nicoll,  Jr.,  professor  of  infectious  diseases  in 
the  University  and  Bellevue  Hospital  Medical  College,  New  York,  has  done  good 
work  on  scarlatina  (1911)  and  poliomyelitis  (1917)  in  children,  and  (with  Josephine 
Pratt)  on  the  infectivity  of  the  bacillus  abortus  in  man  (1915). f Henry  Fred 
Helmholz  (1882-  ) pediatrician  at  the  Mayo  Foundation,  Rochester,  Minne- 

sota, has  investigated  hippuric  acid  in  infants’  urine  (with  S.  Amberg,  1913) 
the  infectious  nature  of  duodenal  ulcer  (with  L.  Gerdine,  1915)  and  the  bac- 
teriology of  the  urine  (with  C.  Beeler,  1916).  In  Jacobi’s  clinic  in  the  German 

* Sedgwick,  Jahrb.  f.  Kinderheilk.,  lxiv  (1906),  p.  194.  Arch.  Pediat.,  xxiii 
(1906),  pp.  414-425. 

f Larson  and  Sedgwick,  Am.  Jour.  Dis.  Child.,  Chicago,  vi  (1913),  p.  326; 
x (1915),  p.  197. 

fNicolland  Pratt.  Ibid.,  x (1915),  203-205. 


150 


HISTORY  OF  PEDIATRICS 


Hospital,  New  York,  an  auto-serum  treatment  for  chorea  has  been  tried  out  by 
Abraham  L.  Goodman  (1916). 


INFANT  MORTALITY  AND  INFANT  WELFARE 

“ De  tout  temps,  l’absence  de  la  mere  et  la  privation  du  sein  et  des  soins  mater- 
nels  ont  ete  le  grand  danger  et  la  principale  cause  de  la  mort  de  l’enfant  au  bereeau.” 
Theophile  Roussel. 

Toward  the  end  of  the  eighteenth  century,  the  subject  of  infant 
mortality  and  its  causes,  shamefully  neglected  in  preceding  ages,  began 
to  engage  the  attention  of  observing  physicians.  In  a Swedish  royal 
decree  of  1748,  the  attention  of  the  state  authorities  is  directed  to  the 
high  infant  mortality  existing  in  Stockholm  and  elsewhere,  and  one  of  the 
causes  assigned  for  it  is  the  lack  of  proper  medical  care  of  the  poor.* 
In  1773,  we  find  a dissertation  of  Verardo  Zeviani,  at  Verona,  Delle 
numerose  morte  dei  bambini.  An  inquiry  into  the  causes  and  the  best 
preventive  measures,  by  J.  Ballexserd,  of  Geneva,  follows  in  1775. 
This  is  translated  into  German  (1776),  and  followed  by  eight  contribu- 
tions of  other  writers  (in  Meissner’s  lists).  In  the  early  nineteenth 
century,  we  find  Meyer  Abrahamson  (1806),  John  Clarke  (1815), 
John  Bunnell  Davis  (1817),  John  Robertson  (1827),  Wilhelm  Rau 
(1836),  Oertel  (1838),  and  many  others  writing  upon  this  theme. 
In  his  Commentaries  (1815),  John  Clarke  judges  of  infant  mortality 
from  the  burial  records: 

“Nearly  a fourth  die  under  two  years  of  age,  and,  of  the  survivors,  about 
a fifth  in  the  succeeding  eight  years,  that,  is  under  ten  years  of  age  . . . More 
than  a third  of  all  the  burials  are  of  children  under  two  years  of  age.” 

These  are  generalizations  from  the  older  “bills  of  mortality” 
established  by  Henry  VIII  (1538).  The  appalling  rates  of  infant 
mortality  in  eighteenth  century  England,  Ireland  and  France  have 
already  been  given.  Underwood  saw  clearly  that  “The  destruction 
of  infants  is  eventually  the  destruction  of  adults,  of  population,  wealth 
and  everything  that  can  prove  useful  to  society  or  add  to  the  grandeur 
of  a kingdom.”  Queen  Anne  lost  all  her  eighteen  or  nineteen  children, 
and  Gibbon,  the  sole  survivor  of  seven  children,  regarded  the  death  of  a 
newborn  child  as,  “an  unnatural,  but  strictly  a probable  event” 
(Holt).  The  mathematician  D’Alembert  lived  to  disown  his  unnatural 
mother,  who  had  abandoned  him  in  the  streets,  and  to  tell  her  that  the 
poor  glazer’s  wife,  who  had  brought  him  up  to  manhood,  was  his  real 
mother.  In  the  “Cursory  Inquiry”  (1817)  of  John  Bunnell  Davis, 
whom  Holt  regards  as  the  most  prominent  pioneer  in  keen  thought 
upon  infant  mortality,!  the  conditions  associated  with  mercenary 

* Medin,  O.,  Jahrb.  f.  Kinderheilk.,  Berlin,  lxxiv  (1911),  p.  490. 

f Holt,  L.  E.,  Proc.  Am.  Assoc.  Study  & Prev.  Inf.  Mortal.  (1913),  p.  33.  For  a 
full  account  of  infant  mortality  and  infant  welfare  activities  in  Europe,  see  Saug- 
lingsfiirsorge  und  Kinderschutz  in  den  europaischen  Staaten,  hrsg.  von  Arthur 
Keller  und  Chr.  J.  Klumker,  Berlin  (1912).  For  American  developments  see 
Philip  Van  Ingen  in  A Half  Century  of  Public  Health  (Ravenel)  New  York,  1921, 
290-322. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


151 


wet-nursing  are  clearly  recognized  as  the  cause  of  most  infants’  deaths, 
maternal  nursing  as  their  best  safeguard.  Davis  founded  the  only 
English  public  dispensary  for  children  in  his  day,  and  had  a remarkable 
prevision  of  modern  social  service  in  his  idea  of  visitations  by  benevo- 
lent ladies  among  the  poor  for  the  purpose  of  looking  after  sick  children 
and  instructing  ignorant  mothers  in  the  art  of  properly  caring  for  their 
infants.  Prior  to  Davis,  Richard  Watt  (1813)  investigated  the  relative 
mortality  from  children’s  diseases  in  1783-1812,  and  concluded  that 
“more  than  half  of  the  human  species  died  before  they  were  ten  years 
of  age  and  of  this  half  more  than  a third  died  of  smallpox,”  which  he 
assumed  to  be  replaced  by  measles  and  other  infections.*  Although 
the  introduction  of  vaccination  brought  about  some  temporary  lower- 
ing of  infant  mortality  in  the  Napoleonic  period,  this  good  result  was 
soon  nullified  by  certain  realignments  in  the  modern  social  order  of 
things.  The  French  and  American  Revolutions  brought  on  social 
democracy  and  industrialism.  The  vast  improvements  in  mechanical 
arts  and  machinery,  with  the  rapid  movement  of  the  rural  population 
to  cities  as  a consequence,  created  a huge  manufacturing  class,  which 
was  in  turn  absorbed  by  a grasping  capitalistic  regime  with  a numerous 
industrial  proletariat  as  its  vassals.  The  skilled  artisan  of  the  past 
was  ruined  by  the  large  manufacturer,  who,  later  on,  was  destined  to  be 
devoured  by  the  capitalist.  The  need  for  cheap  labor  brought  thou- 
sands of  women  into  workshops  and  other  fields  of  activity.  As  a 
reaction  from  the  misery  and  ennui  of  lonely  life  on  the  farm  or  in  the 
squalor  of  slums  and  tenements,  and  in  consequence  of  the  increased 
cost  of  living  in  cities,  there  was  a great  increase  of  prostitution  and, 
therefore,  of  venereal  disease.  These  factors  influenced  infant  mortal- 
ity in  three  ways:  1.  Work  away  from  home  in  factories  caused  mothers 
to  neglect  their  children,  who  were  thus  exposed  to  the  dangers  of 
hand-feeding  or  of  mercenary  wet-nursing.  2.  Factory  life,  under 
unsanitary  conditions,  told  severely  upon  the  health  of  the  mother 
and  consequently  upon  the  child.  3.  Exposure  to  venereal  infection 
either  destroyed  the  child  itself  or  ruined  its  health  at  the  start.  In 
William  Farr’s  data  of  infant  mortality  in  1860-61  cited  by  Holt,f 
the  number  of  deaths  per  1000  registered  births  was:  Sweden,  141; 
Scotland,  149;  England,  170;  France,  223.  In  other  words,  infant 
mortality  was  lowest  in  the  cold,  bracing  climates  of  Scotland  and 
Sweden,  where  poverty  and  a hardy  mode  of  life  made  it  natural  and 
necessary  for  mothers  to  nurse  their  own  children;  higher  in  England, 
where  manufacturing  interests  brought  about  hand-feeding;  highest 
in  France,  where  the  evils  of  mercenary  wet-nursing  and  babv-farming 
were  everywhere  rampant.  “ In  one  province  of  Finland,  where  the 
mortality  was  excessive,  investigation  showed  a great  lack  of  maternal 
nursing”  (Holt).  Wartime • statistics  show  that  when  women  lose 

* See  the  “Historic  Note”  of  A.  K.  Chalmers  in  National  Health  Insurance 
Medical  Research  Committee,  “The  Mortalities  of  Birth,  Infancy  and  Child- 
hood.” London  (1917),  p.  10  et  seq. 

f Holt,  op.  cit.,  p.  35. 


152 


HISTORY  OF  PEDIATRICS 


employment  through  depression  of  business,  the  infant  mortality  rate 
inevitably  falls,  even  though  the  general  death  rate  (as  during  the  siege 
of  Paris)  is  doubled,  for  the  simple  reason  that  mothers  out  of  employ- 
ment are  driven  back  to  breast  feeding  because  they  cannot  afford  to 
purchase  milk  for  hand  feeding.  Holt  emphasizes  the  benign  effect  of 
the  sheer  cheapness  of  breast  feeding  in  this  relation  and  among  the 
poorer  classes  generally.  In  the  present  European  war,  increased 
employment  of  women  in  the  munition  factories  increased  the  rate  of 
infant  mortality  in  France  (Budin),  but  not  in  England.  In  1359-61, 
Sir  John  Simon  and  others  showed  that  the  infant  mortality  curve  rises 
in  direct  proportion  to  the  extent  of  maternal  employment.  As  shown 
in  Rousseau’s  Emile,  this  is  equally  true  of  the  allurements  of  the 
beau  monde,  politics,  women’s  clubs  and  other  feminist  activities. 
“ Joie  de  rue,  douleur  du  maison.”  So  far  as  infant  welfare  is  concerned, 
the  mater  togata  becomes  a home-breaker  rather  than  a home-maker. 
The  infant  has  a much  better  chance  of  surviving  in  rural  or  suburban 
districts  than  in  the  crowded  cities,  but  as  John  Burns  says,  town  life  is 
not  necessarily  bad,  “given  good  mothering,  good  food  and  plenty  of 
it.”  Ashby*  shows  that  infant  mortality  in  the  crowded  Jewish 
quarters  of  towns  is  always  low,  in  spite  of  overcrowding,  defective 
housing  and  poverty,  because  the  Jewish  people  set  a great  deal  of 
store  by  home  life  and  affection  for  children  is  strong  among  them. 
Infant  mortality  is  very  low  in  rural  Ireland  where  maternal  love  is 
strong  through  the  attractive  human  side  of  the  women,  and  where 
poverty  induces  breast  feeding.  It  is  also  low  in  some  parts  of  rural 
England.  During  1730-79,  as  Edmonds  showed,  the  London  mortality 
rate  under  5 years  was  66.2  per  cent-.,  during  1780-1829  only  37.7,  while 
in  1911-15,  it  had  fallen  to  16.8  (Chalmers).  About  1870,  there  began 
to  be  a uniform  decline  in  infant  mortality,  for  reasons  given  below, 
but  there  was  no  general  fall  until  1900,  as  shown  by  the  following 
tables  of  five-year  mortality  in  different  countries  (cited  by  Holt):f 


England 

Ireland 

Scot- 

land 

France 

Germany 

Italy 

Belgium 

Norway 

Sweden 

1881-5 

129 

94 

117 

167 

207 

175 

156 

99 

116 

1886-90 

145 

95 

121 

166 

208 

175 

163 

96 

105 

1891-5 

151 

102 

126 

171 

205 

185 

164 

98 

103 

1896-1900 

156 

106 

129 

159 

201 

168 

158 

96 

101 

1901-5 

138 

98 

120 

139 

190 

168 

148 

81 

92 

The  infantile  mortality  rate  per  1000-for  England  and  Wales  during 
1900-1921  was  154  (1900),  151  (1901),  133  (1902),  132  (1903),  145 
(1904),  128  (1905),  133  (1906),  118  (1907),  121  (1908),  109  (1909), 
105  (1910),  130  (1911),  95  (1912),  108  (1913),  105  (1914),  110  (1915), 
91  (1916),  96  (1917),  97  (1918),  89  (1919),  80  (1920),  83  (1921).  A 


* T.  Ashby,  Hugh,  “Infant  Mortality.”  Cambridge  (1915),  pp.  25-26 
f Holt,  op.  cit.,  p.  38,  footnote. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


153 


sudden  ascent  of  the  curve  in  1904,  1906,  and  1911  is  attributable  to 
unusually  dry,  hot  summers,  or  other  conditions  inimical  to  infant 
welfare,  but  a laudable  decline  in  the  rate  is  noticeable.  The  causes 
of  this  decline  since  1870  and  particularly  since  1900  are  simple. 
After  the  introduction  of  Listerism  (1869-70),  surgical  cleanliness 
became  more  and  more  popular,  and  to  some  extent  affected  milk  and 
stall  hygiene.  In  the  same  period,  the  causes  of  infant  mortality, 
especially  from  diarrhea  were  carefully  studied,  and  medical  officers 
of  health  generally  attempted  to  remove  the  conditions  favoring  it. 
From  1900  onward,  the  movement  for  infant  welfare,  a sort  of  twen- 
tieth century  science,  because  well  established.  The  infant  welfare 
movement  is  mainly  of  French  origin.  Along  with  the  decline  of 
pediatrics  as  a specialty  in  England  and  France  there  has  grown  up 
an  extension  of  social  or  preventive  pediatrics,  which  is  one  of  the 
brightest  phases  of  modern  medicine.  This  has  been  due  to  the  fine 
humanitarian  spirit  of  certain  French  and  English  writers  and 
publicists  and  to  the  brilliant  modern  group  of  talented  English 
public  health  officers,  whose  labors  have  more  than  set  off  the  curious 
disinclination  of  the  English  physician  to  practise  pediatrics  in  and 
for  itself.  On  November  14,  1884,  Firmin  Marbeau  (1798-1875), 
mayor  of  the  first  arrondissement  of  Paris,  founded  the  first  creche 
or  day-nursery,  where  working  mothers  could  leave  their  infants 
in  willow  cradles,  usually  in  charge  of  a nun,  with  two  attendants 
to  rock  the  cradles.  Nine  other  creches  were  founded  in  Paris 
during  1844-A7.  In  1847,  a Societe  des  creches  was  formed,  and  the 
idea  spread  from  France  to  Austria,  Italy  and  Germany.  There  are 
now  creches  all  over  Europe,  usually  supported  by  private  benevolence. 
The  principal  service  of  creches,  according  to  Holt,  has  been  to  arouse 
the  interest  of  the  public  in  regard  to  infant  welfare  and  the  needs  of 
working  mothers.  In  1862,  Victor  Hugo  published  his  great  epic  of  the 
misery  of  the  poor  (Les  Miserables ) and  in  1869,  another  brief  for  child 
protection  ( L’homme  qui  rit).  If  it  be  true,  as  Schiller  says,  that  “the 
brave  man  thinks  of  himself  last  of  all,”  there  can  be  no  more  poignant 
moment  in  literature  than  the  feeling  of  the  long-imprisoned  Jean 
Valjean  that  the  children  confided  to  his  care  will  have  disappeared 
from  life  and  that  he  will  never  see  them  again.  In  the  beautiful 
episode  of  Cosette,  the  evils  of  baby-farming  are  laid  bare,  and  Jean 
Valjean  attains  to  his  full  spiritual  stature  through  his  friendship  for  a 
forlorn  little  child.  These  tokens  of  an  enlarged  interest  in  friendless 
children,  preceded  in  England  by  Oliver  Twist  (1837-38),  Nicholas 
Nickleby  (1838-39),  Old  Curiosity  Shop  (1841),  A Christmas  Carol 
(1841),  and  David  Copperfield  (1850),  were  not  without  their  sequel. 
Sir  Robert  Peel’s  Factory  Health  and  Morals  Act  of  1802  for  the 
preservation  of  the  health  and  morals  of  apprentices  and  employees  in 
cotton  mills  had  little  effect  upon  the  terrible  hardships  endured  by 
English  factory  children  since  the  eighteenth  century.  In  the  vigorous 
humanitarian  agitation  against  child  labor  which  followed,  it  was 
shown  that  children  bound  to  apprenticeship  were,  on  occasion, 


154 


HISTORY  OF  PEDIATRICS 


actually  sold  into  slavery  with  the  effects  of  a bankrupt,  or  transferred 
from  one  hard-hearted,  tight-fisted  taskmaster  to  another;  that 
“cruelties  the  most  heart-rending  were  practised  upon  the  unoffending 
and  friendless  creatures  who  were  thus  consigned  to  the  charge  of 
master  manufacturers;  that  they  were  harassed  to  the  brink  of  death 
by  excess  of  labor,  that  they  were  flogged,  fettered  and  tortured  in  the 
most  exquisite  refinement  of  cruelty;  that  they  were  in  many  cases, 
starved  to  the  bone  while  flogged  to  their  work;  and  that  even,  in  some 
instances,  they  were  driven  to  commit  suicide.”*  It  took  all  the 
spirited  zeal  of  Robert  Owen  (1812-29),  all  the  passionate  eloquence 
of  Richard  Oastler  (1829-33)  and  M.  T.  Sadler  (1829-35),  all  the  able 
pamphleteering  of  William  Cobbett  and  John  Fielden  (1836),  all  the 
tact  and  dignity  of  Peel  and  Lord  Ashley  to  finally  reduce  the  number 
of  working  hours  and  alleviate  the  condition  of  these  unfortunates, 
through  the  Factory  Acts  of  1819,  1833,  1844,  1864,  1867,  1874,  1878, 
and  subsequently.  Infant  mortality  was  vigorously  discussed  at  the 
Dublin  meeting  of  the  National  Society  for  the  Promotion  of  Social 
Science  (1861),  at  the  Philadelphia  meeting  of  the  Social  Science  Associ- 
ation (1871),  at  the  International  Congresses  of  Hygiene  at  Brussels 
(1876),  Paris  (1878),  and  later.  In  1865,  the  Societe  protedrice  de  Ven- 
fance  was  organized  in  France  and  in  1876,  the  Society  for  Nursing 
Mothers  ( Societe  d' allaitement  maternel).  In  1872,  the  English  “Life 
Protection  Act  ” was  passed  requiring  registration,  licensing  and  inspec- 
tion of  all  places  where  infants  were  farmed  out  away  from  their  parents. 
In  1874,  came  the  famous  loi  Roussel , for  the  protection  of  infants  sent 
into  the  provinces  from  Paris  for  wet-nursing.  This  law  required 
government  inspection  of  all  places  where  infants  under  two  years  were 
farmed  out,  nursing  rooms  and  creches  for  all  nursing  mothers  working 
in  factories  and  inspection  of  the  same.  About  20,000  infants  had  been 
sent  out  in  this  way,  with  a subsequent  mortality  of  75  per  cent.  The 
author  of  this  splendid  piece  of  progressive  legislation  was  a physician, 
Theophile  Roussel,  the  most  eminent  of  medical  statesmen,  and  a fore- 
runner of  the  time  predicted  by  Jacques  Loeb,  when  scientific  men  will 
have  a voice  in  legislative  assemblies. 

Theophile  Roussel  (1816-1903),  the  son  of  a country  doctor  in  the 
department  of  Lozere,  graduated  in  medicine  at  the  Paris  Faculty  with 
a dissertation  on  pellagra  (1845),  a subject  which  he  subsequently 
handled  in  two  large  treatises  (1845,  1866),  made  valuable  researches 
on  the  hygiene  of  workers  in  match  factories  (1847),  the  mercury 
miners  at  Almaden  (1847-49)  and  other  occupations,  and  wrote  a life  of 
Pope  Urban  V (1841),  a manual  of  match  fabrication  (1847),  a Con- 
cours  on  the  value  of  physical  signs  in  heart  disease  (1847)  and  studies 
on  correctional  and  preventive  education  (1879).  In  1845,  he  went 
into  politics  and  was  elected  to  represent  his  native  department  of 
Lozere  (1849).  Being  a republican,  he  gave  up  his  seat  after  the  coup 

* Fielden,  John,  “The  Curse  of  the  Factory  System.”  London  (1836),  p.  10, 
cited  by  R.  W.  C.  Taylor  in  “The  Modern  Factory  System.”  London  (1S91), 
p.  189. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


155 


d’etat  (1851)  and  did  not  seek  election  until  after  the  events  of  1870-71, 
when  he  became  deputy  from  the  arrondissement  of  Florae  (1876)  and 
senator  in  1879.  In  1872,  he  took  the  initiative  in  a law  for  suppressing 
public  drunkenness,  which  was  followed  by  the  three  crowning  achieve- 
ments of  his  life,  the  laws  of  De- 
cember 28,  1874,  for  the  protection  of 
infants  sent  out  to  nurse  (loi  Roussel ),* 

■of  July  25,  1889,  for  the  protection  of 
morally  abandoned  or  maltreated 
children,  and  of  July  17,  1893,  for  the 
organization  of  medical  charity.  He 
was  honorary  president  of  the  Societe 
■protedrice  de  Venfance  in  1893.  On 
December  20,  1896,  a touching  jubilee 
was  held  in  his  honor  at  the  Sorbonne. 

Disclaiming  any  credit  for  himself, 

Ftoussel  said,  with  charming  simplicity : 
x‘C’est  la  fete  de  Protection  de 
I’Enfance.”  Modest  to  a fault,  he 
demanded  that  no  eulogies  be  pro- 
nounced at  his  funeral,  but  an  inspec- 
tor general  returning  from  his  native 
Lozere  said:  “That  is  a land  where 
there  are  no  orphans,  for  those  who 
have  lost  their  parents  have  le  pere  Roussel  to  take  care  of  them.” 
The  ruling  principle  of  Roussel’s  life  was  to  translate  charitable 
sentiment  into  enacted  law.  Through  his  persuasive  eloquence  and 
his  personal  charm,  he  came  to  be  known  as  “the  advocate  of 
abandoned  children.”! 

Following  the  loi  Roussel  came  a long  series  of  laws  for  the  protec- 
tion of  maternity,  forbidding  the  employment  of  women  in  factories  for 
a statutory  period  before  and  after  confinement.  The  initiative  was 
taken  by  Switzerland  in  a law  of  1877,  requiring  a rest  of  two  weeks 
before  and  six  weeks  after  the  birth  of  the  child,  the  pre-natal  period 
being  lengthened  by  a law  of  1897.  This  example  was  followed  by 
Hungary  (1884),  Austria  (1885),  Holland  (1889),  Belgium  (1889), 
England  (1891),  Germany  (1891),  Portugal  (1’891),  Norway  (1892), 
Spain  (1900),  Sweden  (1901)  and  Denmark  (1901)  (Holt).  The  first 
consultation  for  nurslings  ( consultation  des  nourrissons) , an  adjunct 
to  maternity  hospitals  at  which  infants  are  regularly  weighed  and  exam- 
ined and  mothers  instructed  in  infant  nutrition  and  hygiene,  was 
organized  by  Pierre  Budin  at  Paris  in  1892.  In  1893,  Variot  began  to 
distribute  milk  at  the  Dispensaire  de  Belleville  (Paris).  The  first  milk 

* For  the  text  of  the  loi  Roussel  and  subsequent  infant  welfare  legislation  in 
France,  see  Sauglingsfiirsorge  und  Kinderschutz  in  den  europaischen  Staaten 
(Keller  and  Klumpke),  Berlin  (1912),  pp.  1266-1325. 

f For  an  extended  account  of  the  career  of  Roussel,  see  F.  Houssay,  Gaz.  med 
de  Paris,  iv  (1904),  12  s.,  pp.  169,  181,  217,  229. 


Fig.  52. — Theophile  Roussel 
(1816-1903). 


156 


HISTORY  OF  PEDIATRICS 


depot  ( goutte  de  lait ) was  established  at  Fecamp  by  Dufour  in  July, 
1894,  with  the  object  not  merely  of  distributing  clean  milk  to  indigent 
mothers,  but  of  encouraging  breast-nursing  in  every  way.  Holt  lists 
the  following  national  and  international  conferences  on  infant  welfare: 

“The  National  Congress  for  Infancy  at  Florence  in  1896;  the  League  against 
Infant  Mortality,  Paris,  in  1902;  the  International  Congress  of  Milk  Depots,  in 
Paris,  in  1905;  the  National  Conference  on  Infant  Mortality,  in  London,  in  1906; 
the  International  Union  for  the  Protection  of  Child  Life,  in  Brussels,  in  1907;  a 
large  exhibit  in  Berlin  in  1908,  portraying  the  problem  of  infant  mortality  in  all 
its  phases;  a second  National  Conference  on  Infant  Mortality,  in  London,  in  1908; 
the  German  Society  for  the  Protection  of  Infants,  in  Munich,  in  1909;  the  American 
Association  for  Study  and  Prevention  of  Infant  Mortality,  organized  at  New  Haven 
in  1909;  the  Third  International  Congress  for  the  Protection  of  Infant  Life,  in 
Berlin,  in  1911;  the  English-speaking  Conference  on  Infant  Mortality,  in  London, 
in  1913.”* 

For  the  widespread  awakening  of  interest  in  infant  mortality,  as 
indicated  by  these  foregatherings,  Holt  assigns  three  causes,  viz.,  the 
growth  and  extension  of  the  humanitarian  spirit,  the  concern  of  modern 
states  about  depopulation,  and  the  great  advances  made  in  preventive 
medicine  during  the  last  thirty  years.  It  is  not  without  reason  that 
France  has  been  the  pioneer  and  principal  advocate  of  infant  welfare 
activities,  for  the  steady  falling  in  the  French  birth  rate  could  only 
spell  national  and  racial  extinction  in  the  end.  And  from  France  came 
the  most  impressive  lesson  in  the  science  of  attacking  the  problem  of 
infant  mortality  at  its  source.  During  the  ten  years  1893-1903,  the 
infant  mortality  of  Villiers-le-Duc,  a small  village  in  the  Cote  d’Or  of 
France,  was  known  to  be  a stable  zero.  This  came  about  in  the  follow- 
ing way.  During  the  period  1804-54,  the  rate  of  infant  mortality  in 
Villiers-le-Duc  fluctuated  between  30  and  20  per  100.  During  the 
period  1854-63,  however,  it  fell  to  a steady  15  per  100.  This  was  due 
to  the  fact  that  the  mayor  of  the  little  commune,  M.  Viorel  de  Villiers, 
was  interested  in  hygienic  problems,  and  applied  certain  rational 
principles  to  the  welfare  of  the  babies  in  his  district.  After  his  death 
(1886),  his  two  successors  took  no  interest  in  these  matters  and  the 
infant  mortality  rate  immediately  went  up  to  30  again.  In  1884,  his 
son,  M.  Morel  de  Villiers,  an  ex-army  officer,  became  mayor,  and 
applied  his  father’s  methods  to  such  good  purpose  that  the  mortality 
rate  immediately  fell  to  15.4  per  100  during  1884-93,  and  to  zero  during 
1893-1903.  In  the  meantime,  M.  Viorel  had  studied  and  graduated  in 
medicine. 

The  methods  of  the  father  were,  in  brief,  the  insurance  of  every  woman  with 
child,  married  or  unmarried,  at  the  expense  of  the  mayoralty  by  the  declaration  of 
pregnancy  before  the  seventh  month;  the  assurance  of  free  medical  aid  out  of  a 
village  fund  in  all  cases  adjudged  dangerous  by  the  midwife;  a grant  of  S0.20  per 
diem  out  of  the  same  fund  to  every  woman  remaining  in  bed  six  days  after  her 
confinement;  compulsory  sterilization  of  milk,  with  appropriate  apparatus,  by  all 
mothers  or  wet-nurses  unable  to  nurse  their  infants  at  the  breast  ; the  systematic 
weighing  of  newborn  infants  every  fortnight  on  a communal  weighing  machine,  as  a 
check  upon  the  infant’s  condition;  the  compulsory  notification  of  any  illness  in  the 


Holt,  op.  tit.,  p.  43 


INFANT  MORTALITY  AND  INFANT  WELFARE 


157 


infant  within  24  hours  after  its  appearance;  the  withdrawal  of  qualification  cer- 
tifications from  all  wet-nurses  not  complying  with  these  regulations,  and  the  award 
of  a bonus  of  $0.50  to  any  nursing  woman  who  could  produce  a one-year-old  child 
in  good  health  as  a result  of  her  nursing  during  the  period  paid  for. 

These  admirable  provisions,*  which  contain  all  the  essentials  of 
recent  infant  welfare  activities  and  which  were  printed  as  a definite 
municipal  ordinance  by  M.  Morel  de  Villiers  on  May  11,  1903, 
attracted  the  attention  of  Benjamin  Broadbent,  who  became  mayor  of 
the  county  borough  of  Huddersfield,  England,  in  order  that  he  might 
get  some  definite  action  on  the  infant  mortality  problem.  Later, 
Dr.  Samson  G.  H.  Moore,  medical  officer  of  health  of  the  same  com- 
munity, took  up  the  question.  During  1892-1902,  the  rate  of  infant 
mortality  in  Huddersfield  was  148  per  1,000  and  in  1902  it  was  138 
per  1,000.  In  1901,  it  was  132,  as  against  182  in  Northumberland,  179 
in  Durham  and  Lancashire,  91  in  Wiltshire  and  95  in  Rutlandshire  and 
Westmoreland.  During  1902-4  Dr.  Moore  made  a careful  analysis 
of  infant  mortality  in  Huddersfield,  in  the  light  of  Morel’s  findings, 
and  his  admirable  report  of  1904,  showing  that  nearly  half  of  the  babies 
had  died  from  preventable  causes,  is  now  exhausted  in  its  fourth  edi- 
tion.! In  November,  1905,  Mr.  Benjamin  Broadbent  was  elected 
mayor  of  Huddersfield,  and  on  November  10,  in  his  mayoral  address, 
he  announced  that,  at  the  birth  of  every  child  born  in  Huddersfield 
during  his  term  of  office,  he  would  issue  a promissory  note  of  £l, 
payable  to  that  child  on  its  first  birthday,  if  it  lived  through  that 
period.  This  announcement  attracted  wide  attention  to  the  cause  of 
infant  welfare  in  the  medical  and  newspaper  press.  In  the  meantime, 
as  a result  of  Dr.  Moore’s  report,  final  approval  had  been  obtained  from 
the  sanitary  authority  (April,  1905)  of  a plan  for  “voluntary  notifica- 
tion of  birth  to  the  medical  officer  of  Huddersfield  and  the  visitation  in 
their  homes  of  all  newly  born  infants,  immediately  after  birth,  by 
women  doctors,  followed  by  voluntary  workers,”  in  order  to  instruct 
the  mother  as  to  the  proper  mode  of  nursing  and  caring  for  her  off- 
spring. Prior  to  1906,  the  English  law  of  1837  required  registration 
of  births  at  any  time  within  42  days  after  birth.  This  arrangement 
delayed  registration  over  six  weeks.  In  1906,  the  Borough  of  Hudders- 
field obtained  parliamentary  powers  requiring  notification  of  all  births 
of  the  medical  officer  of  health  within  48  hours  after  birth.  In  the 
following  year,  Parliament  passed  an  adoptive  Notification  of  Births 
Act  (1907),  requiring  notification  of  birth  in  addition  to  registration, 
by  the  father  or  other  responsible  person,  to  the  medical  officer  of 
health  within  36  hours  after  birth,  under  penalty  of  a fine  of  20s.  In 
1915,  this  Act  was  supplemented  by  the  Notification  of  Births  (Exten- 
sion) Act,  extending  the  1907  Act  to  areas  in  which  it  had  not  been 
adopted,  and  vesting  any  local  authority  with  the  powers  of  a sanitary 

* For  the  text  of  which,  see  Moore,  S.  G.  H.,  Lancet,  London,  i (1916),  p.  944. 
Also  Broadbent,  To  the  Mothers  of  Huddersfield:  An  Open  Letter,  Huddersfield 
(n.d.),  pp.  7-10. 

f Moore,  S.  G.  H.,  County  Borough  of  Huddersfield.  Report  on  Infant 
Mortality.  4 ed.,  Huddersfield  (1907,  vel  subseq.). 


158 


HISTORY  OF  PEDIATRICS 


authority,  under  the  Public  Health  Acts  of  1875-1907  or  the  Public 
Health  (London)  Act,  1901,  for  the  purpose  of  promoting  the  care  of 
expectant  mothers,  nursing  mothers  and  young  children.  In  other 
words,  the  properly  authorized  local  authority  is  empowered  to  follow 
up  all  maternity  cases  to  promote  the  welfare  of  mother  and  child  and 
the  Local  Government  Board  has  latterly  agreed  to  defray  half  the  cost 

of  carrying  out  any  plan  for 
maternal  and  child  welfare  approved 
by  the  Board.  In  1907,  the  infant 
welfare  movement  in  Huddersfield 
came  into  full  operation.  The  in- 
fant mortality  rate  fell  from  134 
per  1,000  in  1906  to  97  in  1907,  the 
locus  of  infant  mortality  remaining 
at  about  that  level  subsequently. 
There  were  similar  activities 
in  other  parts  of  England,  contem- 
poraneous with  those  at  Hudders- 
field. In  1906  Dr.  Archibald  K. 
Chalmers,  medical  officer  of  health 
of  Glasgow,  made  a study  of  infant 
mortality  in  the  Scotch  towns.* 
He  found  every  movement  of  the 
infant  mortality  curve  “an  exag- 
geration,” always  higher  in  Scot- 
land than  in  England,  although  the  general  death  rate  of  England  is 
higher  than  that  of  Scotland,  and  “invariably  lowest  in  Ireland.” 
The  low  rate  of  the  insular  rural  districts  corresponded  with  that  of 
the  residential  suburbs  of  the  large  cities,  and  the  chief  increase 
was  noticeable  in  the  small  towns  and  rural  inland  districts,  rather  than 
the  large  manufacturing  centers.  In  Glasgow,  the  total  rate  was 
lowered  by  15  per  cent..,  representing  a decrease  of  30  per  cent,  in  the 
proportion  of  deaths  during  the  sixth  to  the  twelfth  months,  and 
16  per  cent,  in  the  third  to  the  sixth  months,  while  the  rate  during  the 
first,  three  months  remained  practically  stable.  The  deaths  in  these 
three  months  were  found  not  to  be  due  to  disease  in  the  ordinary  sense, 
but.  to  defective  vitality,  syphilis,  alcoholism,  parental  cell  deteriora- 
tion and  other  ante-natal  causes.  The  hereditary  diseases  threatening 
the  newborn  infant,  are  of  the  kind  which,  in  Chalmers’  phrase, 
“ strike  vertically,”  while  the  ordinary  intercurrent  diseases  of  the  after- 
period have  a lateral  or  casual  incidence.  This  important,  point  was 
sensed  by  Karl  Pearson  when  he  found  it  impossible  to  fit  the  actual 
curve  of  infant,  mortality  into  his  theoretical  curve  without  taking  into 
account  the  whole  range  of  pre-natal  influences. f Thus,  given  the 
* Chalmers,  A.  K.,  Pub.  Health,  London,  xviii  (1905-6),  pp.  409— 43S. 
f “Pearson,  Karl,  The  Chances  of  Death.”  London,  i (1897),  pp.  24-39.  For  a 
statistical  examination  of  the  ante-natal  causes  of  infant  mortality,  see  Fulton 
(J.  S.),  Tr.  Am.  Assoc.  Study  and  Prev.  Inf.  Mortality,  Baltimore,  i (1910).  pp. 
115-152. 


Fig.  53. — Sir  Arthur  Newsholme. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


159 


stationary  character  of  the  death  rate  during  the  first  three  months  of 
life,  vitality  is  “a  quality  of  the  child  at  birth  rather  than  the  accident 
of  its  surroundings  afterwards”  (Chalmers).  In  the  important  reports 
rendered  to  the  Local  Government  Board  by  its  medical  officer,  Sir 
Arthur  Newsholme  (1910),*  it  is  shown  that  “excessive  mortality 
in  infancy  implies  excessive  mortality  in  later  life,  that  there  is  no 
essential  causal  relation  between  a high  birth  rate  and  a high  rate  of 
infant  mortality,”  but  that  “a  high  infant  mortality  implies  a high 
prevalence  of  the  conditions  which  determine  national  inferiority”; 
that  poverty  connotes  a high  infant  death  rate,  although  breast-feeding 
is  commoner  among  the  poor  than  the  rich;  that  early  motherhood 
exerts  a slight  effect  upon  high  infantile  mortality;  that  infant  mortal- 
ity in  the  first  month  of  life  is  preventable,  as  also  the  high  rate  in 
crowded  centers  of  population.  In  his  subsequent  reports  (1913-16), 
Newsholme  shows  that  more  than  half  of  infant  mortality  is  due  to 
infection  from  without,  that  the  large  maternal  and  infant  mortality 
from  puerperal  hemorrhage,  convulsions,  and  septicemia  are  due  to 
bad  midwifery;  that  the  causes  of  infant  mortality  are  many,  e.g., 
maternal  ignorance,  lack  of  medical  attendance  and  nursing,  the 
fecklessness  of  mothers,  poverty,  intemperance,  overcrowding  in  areas 
or  in  rooms,  defective  sanitation,  industrial  employment  of  married 
women,  large  families,  infectious  and  diarrheal  diseases;  and  that  the 
devices  of  infant  welfare  activity  should  be  varied,  viz.,  proper  housing, 
intra-  and  extra-domiciliary  sanitation,  sufficient  and  proper  food, 
notification  of  births,  medical  attention  and  nursing  and  pre-maternity 
work,  including  care,  feeding  and  instruction  of  the  mother.  The 
dictum  of  Sir  George  Newman f that  infant  mortality  is  less  connected 
with  external  conditions  than  with  ignorance  of  the  mother  is 
obviously  one-sided.  Infant  mortality  is  of  multiplex  causation  and 
must  therefore  be  met  by  multiplex  infant  welfare  activities.  “Infant 
mortality,”  says  Newsholme,  “is  the  most  sensitive  index  we  possess  of 
social  welfare  and  of  sanitary  administration,  especially  under  urban 
sanitary  conditions.”  This  sentence  is  the  keynote  of  the  infant 
welfare  movement,  for,  as  Holt  says,  many  whom  the  fanatical  evolu- 
tionists would  regard  as  the  physically  unfit  are  really  “victims  of  a bad 
environment,  improper  feeding  and  neglect.”  A high  infant  mortality 
means  “the  sacrifice  of  the  unfortunate  rather  than  the  unfit ,”  who  must 
be  eliminated  “by  birth,  not  by  death.” 

The  present  infant  welfare  movement  implies  the  widest  extension 
of  the  activities  of  social  medicine,  from  puericulture  or  ante-natal 

* Great  Britain.  Local  Government  Board.  Supplement  to  the  39th  annual 
report,  containing  a report  by  the  Medical  Officer  on  infant  and  child  mortality. 
London  (1910),  pp.  34-36;  74-78,  by  Sir  Arthur  Newsholme.  Later  reports: 
(1907-11),  London  (1913);  Infant  Mortality  in  Lancashire  (1913);  Maternal 
Mortality  (1915);  Child  Mortality  at  Ages  0-5  (1916).  See,  also  Report  of  Local 
Government  Board  on  “Maternity  and  Child  Welfare,”  London  (1917).  For 
a full  account  of  infant  welfare  in  the  United  Kingdom,  see  the  histories  by  A. 
Dingwall  Fordyce  and  T.  J.  Stafford  in  Sauglingsfiirsorge  und  Kinderschutz 
(Keller  and  Klumker),  Berlin  (1912),  pp.  349-440. 

f Newman,  Sir  George,  “Infant  Mortality”  (1906). 


160 


HISTORY  OF  PEDIATRICS 


supervision,  including  pregnancy  clinics,  insurance  of  maternity, 
maternity  homes,  schools  for  mothers;  and  post-natal  supervision, 
from  day  nurseries  {creches),  milk  stations,  nursery  schools,  consulta- 
tions for  nurslings  to  school-inspections,  child-study,  mental  tests, 
school-lunches  ( cantines ),  child-labor  legislation,  child-welfare  activities, 
play  centers,  vocational  aptitude  studies,  instruction  inhome  economics, 
and  training  for  parentage. 

Recent  English  legislation  bearing  on  maternal  and  infant  welfare  comprises, 
besides  the  Notification  of  Births  Acts  of  1907  and  1915,  the  Housing  of  the  Working 
Classes  Acts  (1885-1903),  the  Compulsory  Infectious  Diseases  (Notification) 
Extension  Act  (1899),  the  Factory  and  Workshop  Act  (1901),  the  Midwives  Act 
(1902),  the  Children  Act  (1908),  for  protecting  wet-nursed  infants  beyond  the 
Infant  Life  Protection  Act  of  1897,  the  Housing  and  Town-Planning  Act  (1909), 
the  National  Insurance  Acts  (1911,  1913),  the  Milk  and  Dairies  Act  (Consolida- 
tion) Act  (1915),  the  Public  Health  (Venereal  Diseases)  Regulations  (1916), 
the  Midwives  Act  (1918),  and  other  war  measures.  Florence  Nightingale’s 
letters  of  1891-2  on  health  visiting  in  rural  districts  were  reprinted  in  1911.* 
Milk  depots  were  established  at  St.  Helens  (1899),  Finsbury  (1914,  and  elsewhere. 
The  first  schools  for  mothercraft  were  started  at  St.  Marylebone  (February,  1906) 
as  the  Borough  of  St.  Marylebone  Health  Society,  which  opened  an  Infant  Con- 
sultation on  May  10,  1906.  Winchester  followed  in  December.  1906.  f The  St. 
Pancras  School  for  Mothers  was  founded  in  1907  and  followed  by  other  schools 
at  North  Islington  (1914),  Stockport  (1914)  and  elsewhere.  In  June,  1918,  a long 
list  of  English  welfare  associations  and  schools  for  mothers  was  given  in  the  massive 
report  of  the  Carnegie  United  Kingdom  Trust  on  the  physical  welfare  of  mothers 
and  children  by  E.  W.  Hope  of  Liverpool  and  Miss  Janet  M.  Campbell  (Liverpool, 
1917).  Dr.  Barnardo’s  homes  for  nurslings  at  Hawkshurst,  the  Children’s  Home 
at  Sidcup,  Kent,  the  London  School  for  Myopes,  the  Downs  Ringworm  School  at 
Sutton  (Surrey)  for  children  afflicted  with  tinea,  are  other  phases  of  English 
activities. 

The  first  National  Conference  on  Infantile  Mortality  was  held  in  the  Caxton 
Hall,  Westminster,  on  June  13-14,  1906;  the  second  on  March  23-25,  1908;  the 
third  on  August  4-5,  1913,  all  under  the  presidency  of  John  Burns.  To  these 
conferences  such  able  medical  officers  of  health  as  James  Niven  (Manchester), 
J.  Spottiswoode  Cameron  (Leeds),  G.  F.  M’Cleary  (Hampstead),  James  Robert 
Kaye  (West  Riding),  John  F.  J.  Sykes  (St.  Pancras),  E.  W.  Hope  (Liverpool), 
S.  G.  H.  Moore  (Huddersfield),  A.  W.  Chalmers  (Glasgow),  George  Reid  (Stafford- 
shire), as  also  Mayor  Broadbent,  Sims  Woodhead,  J.  W.  Ballantyne  contributed 
valuable  papers  on  infant  mortality.  At  the  third  conference  Van  Ingen,  Shaw, 
Talbot,  LaFetra  and  other  American  pediatrists  took  part.  International  con- 
gresses for  the  study  and  prevention  of  infant  mortality,  originally  inspired  by  the 
French  Consultations  des  Nourissons  and  the  Gouttes  de  Lait,  have  been  held 
at  Paris  (October  21,  1905),  Brussels  (September  12-16,  1907)  and  Berlin  (Septem- 
ber 11-15,  1911).  In  Canada,  admirable  reports  on  infant  mortality  have  been 
made  to  the  Registrar  General  of  Ontario  by  Dr.  Helen  MacMurchv  (1910-12). 

In  1910,  Dr.  Janet  E.  Lane-Claypon,  on  behalf  of  the  Lister  Insti- 
tute, made  a journey  through  Germany,  Sweden  and  Denmark,  to 
study  modes  of  prevention  of  infant  mortality  .J 

* Letters  from  Miss  Florence  Nightingale  on  Health  Visiting  in  Rural  Districts. 
London,  P.  S.  King  and  Son  (1911). 

t Pritchard,  E.,  Lancet,  London,  i (1917),  p.  352. 

t In  a MS.  kindly  lent  by  Miss  Ellen  C.  Babbitt.  For  the  history  of  infant 
welfare  in  Germany,  see,  also,  Arthur  Keller’s  article  in  Sauglingsfiirsorge  und 
Kinderschutz  (Keller  and  Klumker),  Berlin  (1912),  pp.  185-311. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


161 


German  activities  at  that  time  included  milk  kitchens,  with  baby  consultations 
nost  of  the  large  towns;  maternity  insurance;  nursing  bonuses  of  1.-4.8  marks  to 
thers  who  nurse  their  own  children;  a free  hospital,  established  in  Dresden  by 
ulossmann,  for  all  sick,  illegitimate  or  parentless  children  whose  relatives  could 
n :>t  pay  for  them;  homes  for  illegitimate  or  other  Poor  Law  children,  to  get  them  in 
g od  health  prior  to  boarding  out;  regulations  for  police  supervision  of  all  children 
der  four  who  are  boarded  out  in  German  towns  (1879),  and  revised  regulations 
the  police  inspection  of  these  children  in  Berlin  (1890);  a system  of  -public 
g irdianship  of  illegitimates,  established  at  Leipzig  by  Dr.  Max  Taube  (1904), 
ereby  all  illegitimate  children  born  in  Leipzig  become  at  once  the  wards  of  the 
nicipality  under  his  personal  care;  systems  of  collective  guardianship  of  ille- 
imates  in  Strassburg,  Danzig,  Breslau,  Mannheim,  Freiburg,  Berlin,  Dresden, 
mburg,  Halle,  Kiel  and  other  towns;  a Kinder- Asyl  for  the  reception  of  all  Poor 
w children  in  Berlin  (1901),  Breslau  (1903),  Hamburg  (1907)  and  elsewhere; 
oervision  of  children  in  foster  homes;  a number  of  private  institutions  for  nursing 
m dhers;  the  attempt  to  supply  wet-nurses  in  Dresden  and  Berlin;  syphilitic  nurses 
syphilitic  children;  a few  private  institutions  for  nursing  mothers;  forest  and  sea- 
side homes,  sanatoria  and  holiday  camps  for  sick  and  convalescent  infants;  and  a 
Society  for  the  Prevention  of  Infant  Mortality  which  held  its  first  meeting  at 
Dresden  (1909).  There  is  a sick-insurance  law  protecting  women  six  months 
before  and  six  months  after  childbed;  and  a provision  for  suckling-money  ( Still - 
qdd)  for  working  mothers.  On  June  4,  1909,  the  Kaiserin  Auguste  Victoria  Haus, 
t 1 3 headquarters  of  all  German  efforts  against  infant  mortality,  was  opened  in 
Berlin.  This  institution,  planned  under  the  patronage  of  the  Empress,  and  de- 
ned  to  be  (at  Heubner’s  instance)  “an  institute  for  the  physiological  investiga- 
n of  infant  nutrition,  with  clinical  treatment,”  was  constructed  at  a cost  of 
e $625,000,  collected  by  public  subscription.  It  was  intended  to  be  a model 
ititution  for  scientific  research  on  infants  of  all  ages  and  in  all  states  of  health, 
iere  all  phases  of  infant  life,  post-natal  and  ante-natal,  may  be  found,  with  pro- 
sion  for  the  care  of  confinement  cases  and  sick  babies  from  all  classes  of  society 
d the  training  of  educated  women  as  nurses.  It  is  said  that  the  results  of  this 
travagant  outlay  did  not  come  up  to  expectations.  Germany  is  only  sur- 
ssed  by  Russia,  Austro-Hungary  and  Roumania  in  infant  mortality.  A guard- 
iship  office  and  welfare  station,  for  prompt  financial  aid  and  care  of  expectant 
others  and  their  infants,  exists  at  Charlottenburg.  There  are  also  two  leagues 
oviding  workers  to  take  care  of  a home  during  the  lying-in  period.  On  the 
daetic  side,  effective  object  lessons  were  furnished  at  the  Dresden  Hygienic 
ihibit  in  1911.  The  different  milk-kitchens,  day  nurseries,  infant  hospitals,  etc., 
Ge  rmany  were  shown  on  a map  with  colored  pegs.  The  average  gastro-enteritis 
ortulitv  during  1880-1909  was  shown  to  be  inversely  as  the  scale  of  living,  viz., 
ro  in  the  wealthy,  4.8  per  1,000  in  the  upper  middle  classes,  36.1  in  the  lower 
middle  classes,  and  59  among  the  poor.  The  Wassermann  test  showed  10  per 
nt.  of  latent  syphilis  in  wet-nurses.  The  exhibits  included  correct  clothing  for  a 
iby,  sanitary  and  unsanitary  toys,  unhygienic  nursing  bottles,  models  of  oph- 
ialmia  neonatorum,  degrees  of  dental  development,  the  infant  stomach  and  its 
intents,  casts  of  infant  stools,  models  and  photographs  of  rachitic  infants  and  a 
>x  of  coins,  showing  that  out  of  a working  man’s  income  of  1,380  marks  ($395), 
/j  1 went  for  housing,  560  for  food,  140  for  clothing,  360  for  amusements  and  160 
1 y alcohol.*  It  has  been  objected  against  the  modern  German  care  of  infancy  in 
7 ospitals  that,  in  spite  of  the  splendid  organization  of  applied  science,  the  movement 
as  more  or  less  an  expression  of  the  concern  of  the  metallic  Prussian  bureaucracy 
bout  the  decline  in  the  birth  rate,  and  that  there  was  a certain  lack  of  humanistic 
mothering”  which  is  deemed  so  essential  in  Anglo-Saxon  countries.  “You  have 
eon  all  the  splendid  provisions  for  studying  the  proper  care  of  babies,  but  have  you 
seon  the  babies  themselves?”  was  the  question  put  by  Professor  Medin  of  Stock- 
oAm  to  women  who  were  visiting  the  Berlin  establishments.  The  importance 
attached  to  cradle-songs,  dandling,  fondling  and  other  modes  of  diverting  the  infant 

* For  the  above  facts,  I am  indebted  to  Miss  Ellen  C.  Babbitt. 

: Vol.  I— ll 


162 


HISTORY  OF  PEDIATRICS 


in  Hellenistic  pediatry  is  emphasized  in  Sister  Mary  Rosaria’s  dissertation  “The 
Nurse  in  Greek  Life”  (Boston,  1917).  This  is  naturally  a field  in  which  women 
excel. 

In  Hungary,  under  the  laws  of  1901-3,  every  child  under  15,  if  not  otherwise 
provided  for,  is  entitled  to  state  care,  food,  education  and  a home  (Van  Ingen). 
This  is  managed  by  state  asylums,  each  under  a medical  director,  and  374  State 
Children’s  Colonies,  or  foster  homes.  Delicate,  sickly  children  are  kept  in  the 
asylums  until  they  can  be  entrusted  to  the  foster  parents,  and  are  afterward 
constantly  watched  by  a local  physician  and  visiting  nurses.  Mothers  of  babies 
in  the  asylums  are  given  financial  support  if  they  nurse  them,  and  may  accompany 
them  to  the  foster  homes.  A model  lodging  house  fits  the  unassisted  man  to  get  a 
job  by  fumigating,  cleaning  and  mending  his  clothes  (Babbitt).  Between  $1,500,- 
000  and  $2,000,000  were  expended  for  the  state  care  of  children  in  1910.  The  total 
mortality  of  nurslings  in  asylums  was  11.2  per  100,  and  10.89  in  foster  homes. 

In  Spain,  a Superior  Council  for  Child  Welfare,  presided  over  by  the  Minister 
of  the  Interior,  looks  after  all  children  under  10  years  of  age,  supervises  creches, 
asylums,  hospitals  and  the  training  of  midwives  and  protects  children  in  care  of 
foster  parents.  As  part  of  the  administration  under  the  Superior  Council,  there 
are  49  provincial  bodies  and  over  6,000  local  bodies  which  attend  to  details  of  this 
mode  of  social  service. 

In  Holland,  infant  welfare  is  in  charge  of  Dr.  Saltet,  head  of  the  Health  Depart- 
ment of  Amsterdam  and  professor  of  hygiene  in  the  University.  The  statistics 
show  a low  mortality  rate,  particularly  among  the  Jewish  families  of  Amsterdam, 
among  whom  breast  nursing  is  the  rule.  Between  1895  and  1910,  there  was  a 
decrease  of  55.7  per  cent,  in  the  infant  mortality  rate.  The  obstetrician  Treub 
maintains  that  abortion  is  increasing. 

In  Sweden,  the  Allmanna  Barnhuset  or  Public  Orphanage,  founded  about  1760, 
insures  breast  feeding  for  four  months  after  birth,  by  allowing  the  mother  to 
remain  in  the  institution  with  her  child.  At  the  same  time  she  nurses  another 
child.  This  regulation  once  complied  with,  her  child  is  adopted  as  a ward  of  the 
foundation  for  14  years.  If  the  mother  does  not  comply,  a sum  of  600  kronor 
($162)  must  be  paid  for  the  maintenance  of  the  child,  the  mother  renouncing  all 
rights  to  it  henceforth.  Poor  Law  children  also  become  wards  of  the  Orphanage, 
the  city  of  Stockholm  paying  400  kronor  for  the  maintenance  of  each.  This  applies 
to  poor  children  from  all  parts  of  Sweden.  Children  weaned  at  four  months  are 
boarded  out  with  foster  parents.  About  5,200  children  are  taken  care  of  annually 
and  about  850  babies  in  the  Orphanage.  The  average  mortality  in  the  Orphanage 
was  12.16  per  cent,  in  1894-8  and  10.7  per  cent,  in  1899-1903  (Lane-Claypon). 

In  New  Zealand,  the  Royal  Society  for  the  Health  of  Women  and  Children, 
centralized  in  Dunedin,  with  eight  local  branches  in  other  parts  of  the  dominion, 
and  seventy  subsidiary  committees,  has  done  capital  work.  It  is  sometimes  called 
the  Plunket  Society,  after  the  Governor  General  and  his  wife,  Lord  and  Lady 
Plunket,  who  are  its  patrons.  Its  field  agents  are  the  so-called  Plunket  nurses, 
who,  each  of  them,  look  after  one  of  the  districts  into  which  the  two  islands-  are 
subdivided,  giving  instruction  in  all  branches  of  the  art  of  motherhood,  even  in 
girls’  schools.  There  is  a complete  system  of  birth  registration  and  close  govern- 
ment supervision  of  midwives,  maternity  hospitals,  infant  asylums  and  nurses. 
The  aim  is  essentially  modern,  to  teach  girls  and  women  the  duties  and  respo  'si- 
bilities  of  maternity  and  infant  welfare.  The  result  of  these  activities  has  beeii-ro 
reduce  the  infant  mortality  from  83  to  51  per  1,000  in  ten  years,  while  ~t 
Dunedin  it  is  now  40  per  1,000  (4  per  cent.),  as  against  150  in  Berlin,  120  in 
Paris  and  New  York,  100  in  London.  This  is  the  best  record  yet  obtained  in  a 
community  of  size.  The  highest  infant  mortality  rate  is  that  of  Chile  (333  per 
1000). 

In  the  United  States  the  infant  welfare  movement  is  of  compara- 
tively recent  growth,  partly  owing  to  the  fact  that  there  has  been 
no  uniform  system  of  birth  registration.  New  Zealand,  Hungary 


INFANT  MORTALITY  AND  INFANT  WELFARE 


163 


Germany,  and  Sweden  have  gone  far  to  solve  the  problem  of  poverty  for 
the  people.  New  Zealand  has  solved  the  problem  of  teaching  the 
people  how  to  live.  These  are  paternalistic  activities  carried  forward 
in  populations  practically  homogeneous  in  respect  of  racial  and  national 
sentiment.  Our  problem  is  one  of  heterogeneity  of  race,  racial  psy- 
chology, and  “sectional”  feeling.  It  is  highly  significant,  in  this 
regard,  that  many  of  the  principal  pioneers  and  prime  movers  of  social 
service  in  America  have  been  women.*  Special  credit  is  due  to  Philip 
Van  Ingen  (1875-  ),  of  New  York,  for  his  painstaking  and  valuable 

work  in  assembling  annual  comparative  tables  of  infant  mortality 
from  the  vital  statistics  of  the  health  departments  of  states  and  large 
cities,  prior  to  the  actual  publication  of  these  reports. 

Rochester,  New  York,  was  the  first  American  city  to  have  a Milk  (Welfare) 
Station  (1897),  and  now  maintains  ten  during  the  summer  months.  Boston, 
Chicago,  Cleveland,  Philadelphia,  Richmond  employ  visiting  nurses  for  pre-natal 
work  and  instruction  to  expectant  and  actual  mothers.  In  1902,  a Milk  Fund 
Association  was  started  in  Cleveland,  to  supply  modified  milk  and  medical  atten- 
tion to  infants  brought  to  a central  station.  In  1904,  a farm  was  acquired,  and 
certified  milk  was  thereafter  distributed  instead  of  milk  modified  according  to  a 
percentage  formula.  In  1906,  the  Milk  Fund  Association  combined  with  the 
Visiting  Nurse  Association  to  form  an  infant  clinic,  and  maternal  instruction  was 
then  given  by  visiting  nurses  attached  to  the  clinic.  In  December,  1906,  this  work 
was  taken  over  by  the  Babies’  Dispensary  and  Hospital,  and  in  1907,  the  Milk 
Fund  Association  amalgamated  with  and  turned  over  all  its  property  to  the 
Babies’  Dispensary  and  Hospital.  Branch  dispensaries  (Babies’  Prophylactic 
Dispensaries)  were  then  formed  to  look  after  the  hygiene  of  normal  infants,  while 
the  central  dispensary  attended  to  the  sick.  There  were  six  of  these  branch  estab- 
lishments in  1908,  all  under  one  medical  director  and  one  supervising  nurse.  In 

1910,  a dispensary  building  was  erected,  with  a milk  laboratory,  lecture  room, 
consultation  rooms  and  other  accessories.  In  1911,  Cleveland  appropriated 
$10,000  for  infant  welfare  work  and  established  five  public  prophylactic  dispen- 
saries and  a department  of  child  hygiene  in  charge  of  the  medical  director  of  the 
Babies’  Dispensary  and  Hospital  and  its  supervising  nurse.  By  combining  the 
original  branch  dispensaries,  the  city  had  thirteen  branch  dispensaries  at  the  end  of 

1911.  Special  nurses  now  look  after  infantile  blindness,  foster  homes  for  babies, 
and  the  teaching  of  infant  hygiene  in  girls’  schools.  Finally,  the  medical  director 
of  the  establishment  is  now  professor  of  pediatrics  in  Western  Reserve  University, 
and  eight  hours  in  the  compulsory  curriculum  are  devoted  to  practical  training  in 
infant  welfare  work. 

Up  to  1902,  the  Department  of  Health  of  New  York  City  employed  special 
physicians  to  look  after  sick  babies  in  the  tenements.  In  1903,  visiting  nurses 
were  also  detailed  to  follow  up  these  cases,  and  general  milk  inspection  was  begun. 
On  August  19,  the  Division  of  Child  Hygiene  was  established  with  Dr.  S.  Josephine 
Baker  as  chief,  and  a staff  of  161  medical  inspectors  and  142  nurses.  The  func- 
tions of  this  division  are  the  control  and  supervision  of  midwives,  the  instruction 
of  mothers  in  infant  hygiene,  the  inspection  and  sanitary  supervision  of  day  nur- 
series, the  supervision  of  foundlings  in  foster  horqes  and  institutions  for  dependent 
children,  the  medical  inspection  and  examination  of  school  children  and  the  enforce- 
ment of  the  child  labor  law  in  relation  to  employment  certificates.  In  the  summer 

* Among  these  may  be  mentioned  Miss  Julia  C.  Lathrop  (Washington), 
Dr.  S.  Josephine  Baker  (New  York),  Dr.  Helen  MaeMurchy  (Toronto),  Miss 
Ellen  C.  Babbitt  (Washington),  Dr.  Grace  L.  Meigs  (Washington),  Dr.  Alice 
Hamilton  (New  York),  Dr.  Mary  Sherwood,  Dr.  Lillian  Welsh  and  Miss  Gertrude 
B.  Knipp  (Baltimore),  Mrs.  William  Lowell  Putnam  (Boston),  Miss  Jane  Addams 
(Chicago). 


164 


HISTORY  OF  PEDIATRICS 


of  1911,  79  milk  stations  were  operated,  15  by  the  Health  Department,  31  by  the 
New  York  Milk  Committee,  and  33  by  other  organizations.  An  Infant  Welfare 
Association,  afterward  known  as  the  Babies’  Welfare  Association,  was  formed  by 
the  amalgamation  of  150  different  infant  welfare  associations.  During  1904-10, 
the  average  infant  mortality  in  New  York  was  16,527.  In  1911,  it  fell  to  15,030, 
in  1912,  14,289,  in  1913, 13,797.  The  infant  mortality  rate  fell  from  280  per  1,000 
in  1880  and  144  in  1908  to  102  in  1913.  Outside  of  New  York  City  the  infant  mor- 
tality rate  in  the  state  fell  from  125  in  1913  to  111  in  1914.  The  present  motto 
of  the  New  York  Health  Department  is:  “Public  health  is  purchasable;  and  within 
certain  limits  each  community  may  determine  its  own  death  rate.” 

Work  along  the  same  lines  has  been  done  by  the  Committee  on  Infant  Social 
Service  of  the  Women’s  Municipal  League  of  Boston  (1909),  the  Pregnancy  Clinic 
of  the  Boston  Lying-In  Hospital  (1912),  the  Visiting  Nurse  Association  of  Bridge- 
port, Connecticut  (1912),  the  Social  Service  Department  of  the  Washington 
University  Hospital,  St-.  Louis  (1912),  the  Division  of  Child  Hygiene  of  the  Kansas 
State  Department  of  Health  (1915),  and  similar  organizations  in  Massachusetts, 
Ohio,  Louisiana,  Texas  and  other  states.  Public  lectures,  exhibitions,  exhibit 
cars,  “Little  Mothers’  Leagues,”  and  “Baby  Weeks”  and  “ Better  Babies”  con- 
tests are  varied  features  of  infant  welfare  work.  Nation-wide  Baby  Weeks  were 
held  in  1916  and  1917  under  the  auspices  of  the  Children’s  Bureau  and  the  General 
Federation  of  Women’s  Clubs,  and  1918  was  made  a “Children’s  Year”  for  the 
inauguration  of  a rational  program  of  child  welfare  in  wartime.  A Back-to-Sehool 
drive  was  instituted  October  17,  1918.  In  1915,  there  were  462  infant  welfare 
stations  in  different  American  cities.  Of  these,  290  are  maintained  by  private 
organizations  in  92  cities.  In  1909,  the  American  Association  for  the  Study  and 
Prevention  of  Infant  Mortality  was  organized.  In  1912,  the  United  States 
Government  established  the  Federal  Children’s  Bureau  at  Washington,  under  the 
direction  of  Miss  Julia  C.  Lathrop,  a former  associate  of  Miss  Jane  Addams  at 
Hull  House,  Chicago.  The  object  of  this  Bureau  is  the  investigation  of  “all 
matters  pertaining  to  the  welfare  of  children  and  infant  life.”  The  Children’s 
Bureau  has  made  important  surveys  of  the  status  of  infancy  and  infant  mortality 
in  Johnstown,  Pennsylvania,  Montclair,  New  Jersey,  and  Manchester,  New 
Hampshire.  A complete  life  history  of  every  baby  bom  in  a particular  year  in 
these  localities  has  been  obtained,  and  if  the  baby  died  within  the  year,  the  causes 
of  death  were  investigated.  In  Johnstown,  a city  made  up  largely  of  East  Euro- 
pean immigrants,  it  was  shown  that  there  is  a direct  relation  between  bad  sanita- 
tion, multiplex  household  drudgery  and  the  varying  mortality  in  the  different 
wards.  As  shown  at  the  Dresden  Hygienic  Exhibit,  the  infantile  death  rate  is 
inversely  as  the  annual  income  of  the  father.  The  average  infantile  death  rate  in 
Johnstown  is  134  per  1,000,  but  264  among  the  Serbo-Croats  alone.  In  Montclair, 
a wealthy  residential  community,  it  is  84.  In  Manchester,  an  industrial  town, 
it  is  193,  the  principal  cause  being  the  daily  occupation  of  the  mothers  in  the 
textile  mills.  Among  the  English,  Irish  and  Scotch,  the  rate  is  66  per  1,000; 
among  the  French  Canadians,  it  is  248.  Artificial  feeding  and  unduly  large  families 
explain  the  difference.* 

By  the  passage  of  the  Congressional  act,  effective  September  1,  1917,  the  powers 
of  the  Children’s  Bureau  have  been  enlarged  by  the  establishment  of  a Child  Labor 
Division  to  carry  out  the  intent  of  the  law.  Recent  American  Child  Welfare 

* For  the  information  convened  in  this  section,  I am  much  indebted  to  the 
articles  of  Ellen  C.  Babbitt,  Tr.  Am.  Assoc.  Study  and  Prev.  Inf.  Mortal.,  1911, 
Baltimore,  ii  (1912),  pp.  64-71;  L.  Emmet  Holt,  Ibid.,  iv  (1913),  pp.  1-54;  E.  B. 
Phelps,  Tr.  Internat.  Cong.  Hyg.  and  Demog.  (1912),  Washington,  vi  (1913), 
pp.  132-183;  Philip  Van  Ingen,  Am.  Jour.  Dis.  Child.,  Chicago,  vii  (1914),  p.  471; 
x (1915),  p.  212;  Grace  L,  Meigs,  Ibid.,  xiv  (1917),  pp.  ISO-197;  and  to  the  rich 
supply  of  literature  and  public  documents  on  infant  welfare  kindly  supplied  me 
by  Miss  Babbitt  and  Miss  Gertrude  B.  Knipp  (Baltimore).  For  the  activities  of 
the  Children’s  Bureau,  Washington,  see  Miss  Lathrop’s  reports  (I-VII,  1913-19), 
and  the  many  publications  of  the  Bureau. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


165 


acti  ities  culminated  in  the  Sheppard-Towner  Bill  (December,  1921)  by  which 
governmental  aid  is  extended  to  states  for  the  organizing  of  Divisions  of  Child 
Hygiene  in  the  State  departments  of  health  or  to  assist  those  already  formed. 

As  a rule,  the  larger  the  family,  the  higher  the  infant  death  rate. 
Unwelcome  children  are  not  usually  well  cared  for.  Heartless  parents 
will  even  allow  children  to  die  on  their  hands  by  starvation  or  exposure 
(Engelmacherei) . This  brings  up  the  question  of  birth-control.  As 
stated  by  Dr.  Jacobi  in  1915,  the  object  of  birth-control  is  to  limit 
reckless  and  irresponsible  begetting  of  children  by  deliberately  regu- 
lating their  number  and  the  time  of  their  arrival.  It  is  maintained  by 
the  opponents  of  birth-control  that,  on  the  continent  of  Europe,  where 
control  is  a commonplace  right  of  women,  the  liberty  has  been  a main 
coefficient  in  bringing  about  the  depopulation  of  modem  states  and 
that,  in  the  United  States,  it  has  the  disadvantage  of  being  connected 
with  the  sordid  interests  of  “sexually  exploited  women”  and  of  com- 
mercial drug  firms.  The  present  European  war  goes  to  show  that  a 
country  with  a small  population  may  be  in  danger  of  being  over- 
whelmed by  a country  with  a teeming  population,  bred  for  military 
purposes.  But,  other  things  being  equal,  it  cannot  be  denied  that  the 
general  ideal  of  advanced  modern  states  (at  least  in  crowded  cities) 
would  be  the  moderate  sized  family;  in  other  words,  fewer  but  better 
children.  Bernard  Shaw  closes  with  the  subject  in  the  following 
aphorisms : 

“The  essential  function  of  marriage  is  the  continuance  of  the  race,  as  stated  in 
the  Book  of  Common  Prayer.  The  accidental  function  of  marriage  is  the  grati- 
fication of  the  amoristic  sentiment  of  mankind.  The  artificial  sterilization  of 
marriage  makes  it  possible  for  marriage  to  fulfill  its  accidental  function  while  neg- 
lecting its  essential  one.  The  most  revolutionary  invention  of  the  XIX  Century 
was  the  artificial  sterilization  of  marriage.” 

These  sentences  reveal  to  what  extent  the  religious  and  moral 
inhibitions  of  the  past  have  broken  down  under  the  influence  of  modern 
philosophy.  In  another  place,  Shaw  observes  that : 

“If  we  desire  to  maintain  the  population  at  its  present  figure  or  to  increase  it, 
we  must  take  immediate  steps  to  induce  people  of  moderate  means  to  marry 
earlier  or  to  have  more  children.  . . The  population  declines  because  the  high 
birth  rate  of  the  very  poor  is  counterbalanced  by  a huge  infantile  mortality  in  the 
slums,  whilst  the  very  rich  are  also  the  very  few  and  are  becoming  sterilized  by  the 
spreading  revolt  of  the  women  against  excessive  childbearing — sometimes  against 
any  childbearing.” 

In  spite  of  the  advantages  of  early  marriages — viz.,  that  they  are  apt 
to  be  more  durable  and  that  the  early  married  are  able  to  establish  their 
children  in  life  before  they  die — the  depopulation  of  modern  states 
continues  because  the  conditions  of  modern  life  are  such  that  most 
people  are  financially  unable  to  marry  early  and  because  few  modern 
women  are  physically  adapted  or  mentally  inclined  to  the  demands  of 
multiparity.  Thus  the  birth  rate  of  a nation  in  any  period,  as  Have- 
lock Ellis  maintains,  is  regulated  automatically  by  social  and  economic 
conditions.  Lecky,  in  the  “Map  of  Life,”  contends  that  the  two 
influences  which  “inevitably  and  powerfully  tend  to  depress  the  vital- 


166 


HISTORY  OF  PEDIATRICS 


ity  of  a nation”  are  “sanitary  science  itself,  which  enables  great 
numbers  of  constitutionally  weak  children,  who  in  other  days  would 
have  died  in  infancy,  to  grow  up  and  marry  and  propagate  their 
offspring”  and  “the  steady  movement  of  populations  to  towns.”  He 
concludes  that  “the  great  diminution  in  infant  mortality  is  in  truth  a 
very  doubtful  blessing.”  But  these  Tory  squire  arguments  are 
pulverized  by  the  very  fact  that  the  infant  welfare  movement  origi- 
nated, in  the  first  instance,  from  a general  alarm  about  the  depopula- 
tion of  modern  states;  while  statistics  have  proven  to  the  hilt  the 
theorem  of  Newsholme  that  a high  infant  mortality  rate  in  a crowded 
modern  community  connotes  a high  general  mortality  and  a specific 
lowering  of  vitality  in  that  community.  It  was  formerly  supposed 
that  the  weakest  went  to  the  wall,  and  women,  even  in  our  own  time, 
would  say  of  a dead  infant:  “It  is  better  off  in  heaven.”  But  the 
causes  of  a high  infant  mortality  are  of  a kind  that  really  affect  all 
infants  and  all  adults.  In  the  past,  when  there  were  not  so  many 
people  in  the  world,  the  law  of  the  survival  of  the  strong  and  brutal 
obtained  with  full  force  and  “coward  Adam”  first  made  definite  war 
upon  the  defenseless  infant.  Today,  he  has  grown  a little  ashamed  of 
himself.  The  main  issue  at  stake  in  the  present  European  war  was  to 
determine  whether  overbearing  power  can  continue  to  play  the 
cowardly  bully  toward  the  weak  or  wreak  vindictive  spite  upon  the 
defenseless. 

In  wartime,  infant  welfare  activities  acquire  an  additional 
prospective  value  through  the  fact  that  as  the  population  continues 
to  be  killed  off  in  the  warring  countries,  the  infants  who  are  to  replace 
them  become  more  and  more  of  a national  asset.  In  all  these  countries, 
the  birth  rate  has  been  steadily  decreasing  of  late  years. 

In  England,  the  starting  point  of  preventive,  as  distinguished  from  palliative, 
infant  welfare  work,  was  a memorandum  of  the  Local  Government  Board,  of  date 
July  30,  1914,  outlining  measures  for  ante-natal,  natal  and  post-natal  care,  includ- 
ing systematic  maternal  and  child  welfare  activities  and  insurance  of  maternity 
by  means  of  a liberal  grant  of  money  from  Parliament.  Hospital  treatment  for 
infants,  food  for  expectant  and  nursing  mothers  and  infants  under  five,  creches, 
day  nurseries,  homes  for  deserted  and  illegitimate  children,  etc.,  were  further  pro- 
vided for  in  the  Circular  of  the  Local  Government  Board  of  August  9,  1918.  In 
spite  of  the  fact  that  millions  of  women  were  eventually  engaged  in  munition  and 
other  war-industries,  the  infant  death  rate  steadily  declined.  The  passage  of  the 
Notification  of  Births  (Extension)  Act  in  1915  insured  compulsory  notification  of 
births  in  all  parts  of  the  British  Isles  within  36  hours  after  birth.  In  March, 
1914,  there  were  600  health  visitors  for  the  metropolitan  boroughs,  and  in  Feb- 
ruary, 1917,  there  were  1,445,  and  800  district  nurses.  In  June,  1918,  there  were 
700  centers  for  maternity  and  infant  welfare  work,  established  by  local  authorities, 
578  by  voluntary  societies,  751  whole-time  health  visitors,  760  part-time  health 
visitors,  1,044  district  nurses  engaged  by  local  authorities  and  320  additional  health 
visitors  in  the  employment  of  voluntary  societies.*  The  infant  death  rate  of 
England  and  Wales  in  1891-1900  was  153,  in  1901-10,  128,  in  1911-15,  110,  and  in 
1916,  91,  the  lowest  then  attained.  The  birth  rate  was  23  in  1914-15,  22  in  1915— 
16,  and  20.9  in  1916-17.  In  Scotland,  the  infant  death  rate  fell  from  126  in  1915  to 
97  in  1916,  also  the  lowest  on  record.  On  July  2-7,  1917,  a National  Baby  Week 
* Newsholme,  Sir  A.,  U.  S.  Dept.  Labor  Child.  Bureau,  Standards  of  Child 
Welfare,  Rep.  Child.  Bureau  Conf.,  Washington  (1919),  p.  279. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


167 


exhibition  was  held  in  Central  Hall,  Westminster,  as  part  of  a general  campaign 
of  education.  Maternity  is  practically  insured  and  child  welfare  up  to  school  age 
is  forwarded.  The  Board  of  Education  offers  grants  for  mothers’  schools  and  day 
nurseries,  with  standardized  methods  of  procedure.  Under  the  National  Insurance 
Act,  £650,000  were  appropriated  in  1914—15  to  cover  the  deficit  caused  by  the 
high  sick  rate  among  married  women.  * 

In  Paris,  the  Office  central  d’ assistance  maternelle  et  infantile  was  organized 
in  August,  1914,  to  insure  public  care  of  every  pregnant  woman  and  every  child 
under  three,  “to  be  sure  that  no  woman  is  ignored  and  no  child  forgotten.”  The 
eleven  maternities  of  the  Assistance  publique  (the  official  agency  of  Parisian  charity) 
took  care  of  public  confinements  among  the  poor,  the  Mairies  furnished  obstetric 
assistance  at  home,  free  consultation  centers  for  pregnancy  were  established  every- 
where, military  ambulances  carried  women  to  the  hospitals,  cantines  maternelles 
supplied  meals  to  pregnant  women,  military  allowances  were  given  to  the  mothers 
of  soldiers’  children,  a government  maternity  grant  was  established  on  June  13, 
1913,  and  long  debates  have  been  held  in  the  Academy  of  Medicine  as  to  the 
hygiene  of  pregnant  women  working  in  munition  factories.  La  Mutualite  mater- 
nelle, with  over  50  consultation  centers  in  Paris  and  elsewhere,  insured  the  pay- 
ment of  12  francs  a week  to  mothers  and  10  francs  if  they  nurse  the  child.  Senator 
Paul  Strauss’s  law  of  August,  1914,  allocates  1 franc  daily  to  a prospective  mother 
for  a month  before  the  birth  of  her  child  and  1 francs  daily  for  four  weeks  after, 
which  has  increased  the  birth  rate.  In  1915-16,  95.2  per  cent,  of  all  labor  cases  were 
cared  for  by  the  Assistance  publique  (Pinard ) and  the  birth  rate  in  this  period  was  little 
more  than  half  of  that  in  1913-14.  The  rates  of  infant  and  maternal  mortality  and 
of  still-births  fell  in  1914-15  and  rose  in  1915-16,  along  with  the  number  of  aban- 
doned infants,  which  Pinard  explains  by  the  increased  employment  of  women 
in  munition  and  other  factories.  Eventually,  the  French  infants  were  cared  for 
in  wards  attached  to  the  munition  factories,  and  the  working  mothers  were  allowed 
to  nurse  them  at  intervals.  With  a deficiency  of  25  to  50  per  cent,  of  physicians 
in  the  larger  cities,  with  800,000  women  employed  in  munition  factories,  with  an 
infant  mortality  rate  of  126  in  1917,  and  with  a war  birth  rate  50  per  cent,  less  than 
normal  and  at  least  40  per  cent,  below  the  total  death  rate,  it  became  obvious  that 
France  was  facing  national  extinction.  During  the  whole  period  of  the  war,  the 
discussion  of  the  high  infant  mortality  and  the  low  birth  rate  went  on  in  the 
Academy  of  Medicine,  Pinard  taking  a strong  stand  against  the  employment  of 
women  as  munition  workers.  In  July,  1917,  the  Children’s  Bureau  of  the  Ameri- 
can Red  Cross  began  its  activities  with  eleven  members  under  the  direction  of 
William  Palmer  Lucas;  by  July,  1918,  it  had  over  400  members  and  its  activities 
extended  over  the  whole  area  of  France.  In  the  Toul  sector,  J.  P.  Sedgwick  soon 
installed  a colony  of  over  500  mothers  and  children  and  established  a children’s 
hospital  of  200  beds,  with  chains  of  dispensaries  in  the  smaller  towns.  This  idea 
was  carried  through  the  whole  war  zone  under  the  direction  of  Maynard  Ladd, 
and,  in  Paris,  the  dispensary  service  was  established  by  J.  A.  Miller.  At  Evian, 
where  a contagious  diseases  hospital  of  200  beds  was  established  under  C.  F.  Gels- 
ton,  over  40,000  children  of  rapatries  were  examined  and  treated,  with  dispensary 
service.  At  Lyons,  a dispensary,  hospital  and  barracks  for  refugee  children  were 
established,  and  a baby-show  exposition,  attended  by  over  170,000  people,  was 
held  on  April  9 and  three  weeks  after,  under  the  direction  of  C.  J.  Grulee  and, 
later,  of  Miss  Ellen  C.  Babbitt.  In  June,  this  exhibit  was  transferred  to  Marseilles, 
and  extended  to  other  cities.  The  guignol,  the  cinema,  cartoons,  posters  and  pic- 
ture post-cards  were  freely  used,  and  a special  educational  bureau  endeavored  to 
reach  the  public  through  pamphleteering  and  the  press.  Special  supplemental 
lunches  for  school  children  were  developed  by  Mason  Knox  and  Manning,  f 

* See  Great  Britain.  Local  Government  Board.  Maternity  and  Child 
Welfare.  (Circulars,  regulations  and  memoranda.)  London  (1916). 

f See:  Lucas,  W.  P.,  Jour.  Am.  Med.  Assoc.,  Chicago,  lxxii  (1918),  pp.  359-362; 
Am.  Jour.  Dis.  Child.,  Chicago,  xvi  (1918),  pp.  212-219.  Grulee  (C.  G.),  Am. 
Jour.  Dis.  Child.,  Chicago,  xvi  (1918),  pp.  220-225.  Knox  (J.  M.),  Ibid.,  pp. 
242-252. 


168 


HISTORY  OF  PEDIATRICS 


In  Belgium,  William  Palmer  Lucas  reported  indications  of  a decrease  in  infant 
mortality  rate  in  the  large  cities  (except  Mons),  largely  due  to  the  canteens  for 
feeding  expectant  and  nursing  mothers  and  infants  under  three. 

In  Germany,  there  was  a falling  off  of  over  two  million  births  during  the  first 
three  years  of  the  war,  so  that  40  per  cent,  fewer  babies  were  born  in  1916  than  in 
1913,  as  compared  with  the  11  per  cent,  fall  in  England;  but  while  the  infant  death 
rate  rose  from  151  per  1,000  in  1913,  to  164  per  1,000  in  1914,  it  was  markedly 
reduced  in  1915-16,  and  well  kept  down  thereafter.  Even  in  the  early  months 
of  the  war,  it  was  not  as  high  as  in  the  dry,  hot  months  of  1911  (192  per  1,000). 
In  consequence  of  mobilization,  there  was  a sudden  interruption  of  infant  welfare 
work  in  nearly  all  German  towns.  The  doctors  in  charge  were  called  to  the  colors 
for  military  duty,  the  welfare  workers  were  taken  for  army  nursing,  and  many 
infants’  homes  were  turned  into  military  hospitals.  One-fourth  of  all  the  Hessian 
welfare  centers  were  closed,  and  five  out  of  fourteen  in  Cologne.  Even  mothers 
frequently  neglected  their  infants  during  this  exciting  period.  In  a letter  of 
August  12,  the  Kaiserin  pointed  out  the  fatal  error  of  neglecting  infant  welfare  work 
for  military  considerations,  but  its  revival  was  due  to  alarm  over  the  sudden  increase 
in  infant  mortality  from  August,  1914.  The  imperial  allowances  for  soldiers’ 
wives  and  children  fixed  by  the  law  of  August  4,  1914  were  increased  over  four- 
and  two-fold  during  the  war,  the  maternity  benefits  under  the  Imperial  Insurance 
Law  of  1910  were  liberally  extended,  a Federal  Order  authorizing  imperial  grants 
appeared  on  December  3,  1914,  and  was  extended  even  to  the  wives  of  men  on 
patriotic  auxiliary  service  on  July  6,  1917.  There  was  a special  grant  for  women 
who  breast-fed  their  babies.  By  1915,  there  were  nearly  800  infant  welfare  asso- 
ciations in  550  localities,  271  day  nurseries,  and  266  maternal  institutions,  but  in 
some  localities  these  were  entirely  lacking.  The  Kaiserin  Auguste  Victoria  Haus 
continued  to  be  the  center  of  infant  welfare  activities.  Rickets  and  infantile 
diarrhea  were  alarmingly  prevalent  in  1915-16,  and  some  physicians  observed  a 
special  kind  of  war  infants  ( Kriegsneugeborene ),  not  premature,  but  under-devel- 
oped at  birth,  with  symptoms  of  constant  restlessness  and  automatic  grasping 
movements.  * 

In  Canada,  much  has  been  done  by  Baby  Week  campaigning  and  the  care  of 
dependents  of  enlisted  men.  The  valuable  work  of  Miss  Helen  MacMurchy  in 
Toronto  has  already  been  mentioned.  Many  of  the  Victorian  Order  of  Nurses 
Went  for  duty  overseas.  Of  American  pediatrists,  Knox,  Sedgwick,  Lucas, 
Veeder,  Ladd,  Grulee,  Manning  and  others  were  active  in  infant  welfare  work  in 
the  war  zones. 

It  has  now  been  attempted  to  give  an  outline  of  the  history  of 
pediatrics  from  its  earliest  beginnings  to  the  present  hour.  If  the 
exigencies  of  military  duty  have  not  permitted  as  exhaustive  a study 
as  might  otherwise  have  been  undertaken,  I trust  that  enough  has  at 
least  been  presented  to  show  the  tremendous  growth  and  importance  of 
the  science  in  recent  years.  Perhaps,  like  the  infant  itself,  the  subject 
of  pediatrics  first  began  to  attract  the  attention  of  physicians  through 
its  very  helplessness.  No  less  than  fifteen  army  surgeons  mentioned 
in  these  pages  have  done  much  to  forward  this  science,  and  the  large 
number  of  pediatrists  who  have  taken  up  infant  welfare  work  in  the 
present  war  goes  to  show  the  truth  of  Langstein’s  observation  that 
“children  are  to  be  regarded  as  the  most  valuable  capital  of  the  state." 
This  was,  in  fact,  the  view  of  the  earlier  German  publicists,  Siissmilch 
and  Peter  Frank. 

Our  bead-roll  of  benefactors  of  child-life  includes  Hippocrates,  the 

* Infant  Welfare  in  Germany  during  the  War.  Report  prepared  in  the  Intelli- 
gence Department  of  the  Local  Government  Board,  London,  191S. 


INFANT  MORTALITY  AND  INFANT  WELFARE 


169 


founder  of  internal  medicine  and  of  infantile  orthopedics;  Soranus, 
who  wrote  the  first  individualized  treatise  on  infant  hygiene;  Arch- 
bishop Datheus  of  Milan,  who  originated  the  foundling  asylum;  St. 
Vincent  de  Paul,  the  patron  of  friendless  children,  whose  charitable 
endeavors  led  to  the  foundation  of  the  Hospice  des  enfants  trouves 
(1640);  George  Armstrong,  who  founded  the  first  dispensary  for 
children  (1769);  Johann  Peter  Frank,  the  pioneer  of  school  hygiene 
(1779);  Count  Rumford,  who  originated  school  lunches  for  children 
(1792);  John  Bunnell  Davis,  who  adumbrated  the  modern  methods  of 
lowering  the  mortality  of  infants  (1817);  Morel  de  Villiers,  Benjamin 
Broadbent  and  S.  G.  H.  Moore,  of  Huddersfield,  and  Sir  Arthur 
Newsholme,  who  made  them  accomplished  fact;  Semmelweis  and 
Crede,  who  made  the  prevention  of  puerperal  septicemia  and  infantile 
conjunctivitis  viable;  Theophile  Roussel,  the  physician-legislator, 
whose  beneficent  laws  for  the  protection  of  children  have  been  our 
models;  O’Dwyer,  the  inventor  of  intubation;  Roux  and  von  Behring, 
the  discoverers  of  antitoxin;  Grancher,  the  originator  of  isolation 
cubicles  and  of  surgical  cleanliness  in  children’s  wards  in  hospitals; 
Soxhlet,  Rotch,  Coit,  Schlossmann  and  others  who  have  made  “clean 
milk”  possible;  the  many  investigators  of  infant  nutrition  and  metab- 
olism; and  the  great  humanistic  pediatrists,  like  Charles  West,  Jacobi 
and  J.  Lewis  Smith,  who  have  practised  this  branch  of  medicine,  not 
merely  as  a scientific  specialty,  but  from  genuine  love  of  the  children 
themselves.  Nor  should  we  forget  the  artists,  the  musicians,  the 
poets  and  men  of  letters  who  have  added  such  a warm  human  interest 
to  child-study. 

Contrast  the  utterances  of  the  past,  which  meted  out  nothing  to 
childhood  but  a frown  of  disapproval,  with  the  larger,  more  tolerant 
attitude  of  modern  writers: 

“It  is  better  to  keep  children  to  their  duty  by  a sense  of  honor  and  by  kindness 
than  by  fear  of  punishment.”  Tertullian. 

“Nothing  has  a better  influence  on  children  than  praise.”  Sir  Philip  Sidney. 

“I  would  not  have  children  much  beaten  for  their  faults,  because  I would  not 
have  them  think  bodily  pain  the  greater  punishment.”  Locke. 

“Children  are  very  nice  observers,  and  they  will  often  perceive  your  slightest 
defects.  In  general,  those  who  govern  children  forgive  nothing  in  them,  but 
everything  in  themselves.”  Fenelon. 

“Dispel  not  the  happy  illusions  of  childhood.”  Goethe. 

“Where  on  earth  is  there  so  much  society  as  in  a beloved  child?”  Landor. 

“Children  have  more  need  of  models  than  of  critics.”  Joubert. 

“Do  not  try  to  produce  an  ideal  child;  it  would  find  unfitness  in  the  world.” 
Hebert  Spencer. 

“The  vilest  abortionist  is  he  who  attempts  to  mould  a child’s  character.” 
Bernard  Shaw. 

“The  best  brought  up  children  are  those  who  have  seen  their  parents  as  they 
are.  Hypocrisy  is  not  the  parent’s  first  duty.”  Bernard  Shaw. 

“Not  one  book  in  a thousand  is  worth  as  much  to  mankind  as  an  innocent  little 
child  or  a Chicago  ham.”  H.  L.  Mencken. 

In  conclusion,  I wish  to  acknowledge  the  generous  and  valuable 
assistance  which  has  been  rendered  me  by  some  of  the  most  eminent 
pediatrists  in  this  country,  whom  I have  approached  in  the  spirit 


170 


HISTORY  OF  PEDIATRICS 


advocated  by  a prominent  writer  on  child-study : “ Only  the  sham  knows 
everything:  the  trained  man  understands  how  little  the  mind  of  any 
individual  may  grasp,  and  how  many  must  cooperate  in  order  to 
explain  the  very  simplest  things.”*  My  correspondence  with  these 
gentlemen  has  been  truly  delightful  and  from  their  expressions  about 
one  another,  I may  (in  the  droll  expression  of  Stendhal)  “augur” 
the  existence  of  a larger  degree  of  fraternal  feeling  than  exists  in  some 
other  branches  of  medicine.  Such  followers  of  the  pediatric  art  and 
science  as  I have  known  have  seemed,  for  the  most  part,  genial,  helpful, 
unassuming  men,  men  inclined  to  minimize  their  own  talents,  a trait 
rare  in  physicians,  although  the  chief  end  of  pediatrics  is  the  mainte- 
nance of  the  family  and  the  perpetuation  of  the  human  race. 

* Gross,  Hans. 


CHAPTER  II 


CONGENITAL  AND  ACQUIRED  PREDISPOSITION 
AND  HEREDITY 

By  Clarence  C.  Little,  S.  D. 

Cold  Springs  Harbor,  New  York 

L INTRODUCTION 

The  last  twenty  years  have  witnessed  the  birth  and  vigorous  growth 
of  the  experimental  investigation  of  the  phenomena  of  inheritance.  The 
field  has  proved  so  fertile  that  even  those  who  are  engaged  actively 
in  this  research  have  found  it  difficult  to  keep  track  of  the  immense 
array  of  facts  which  has  sprung  up. 

It  is  not  surprising,  therefore,  that  in  the  past  geneticists  have  not 
made  any  considerable  effort  to  present  the  more  important  discoveries 
in  their  science  to  workers  in  the  allied  sciences.  Until  lately  they 
have  been  classifying  and  analyzing  the  data  obtained  by  the  numer- 
ous investigators  in  their  own  field.  Now,  however,  has  come  the 
opportunity,  and  indeed  the  obligation  to  consider  the  bearing  of 
the  main  discoveries  in  enegtics  upon  anthropology,  agriculture,  and 
medicine,  and  to  visualize,  even  though  it  be  imperfectly,  the  opportu- 
nity for  cooperation  and  mutual  gain  in  the  bringing  to  the  attention  of 
investigators  or  practitioners  in  these  fields  the  particular  discoveries 
in  genetics  which  should  prove  of  immediate  and  permanent  interest 
in  their  work. 

Various  factors  such  as  slow  breeding,  and  relatively  small  families 
have  proved  handicaps  in  the  study  of  human  genetics.  Yet  a notable 
array  of  facts  have  been  obtained  from  investigation  in  this  field,  and 
these  together  with  the  results  of  breeding  experiments  with  plants 
and  lower  animals  have  pointed  to  the  conclusion  that  closer  coopera- 
tion and  mutual  understanding  between  genetics  and  medicine  is  now 
a natural  relationship  which  must  be  brought  about. 

The  great  majority  of  genetic  discoveries  have  been  made  since 
1900.  Their  recognition  and  appreciation  will  gradually  lead  to  the 
adoption  by  medical  men  in  general  and  by  obstetricians  and  pediatri- 
cians in  particular  of  a biological  point  of  view  which  will  aid  immensely 
in  reducing  to  an  analyzable  and  predictable  condition  data  that  would 
otherwise  remain  unexplained  and  devoid  of  significance.  Thus 
medical  men  must  be  made  aware  of  the  chief  facts  and  discoveries 
resulting  from  genetic  investigation  in  such  subjects  as  sex  determina- 
tion, the  physical  basis  of  heredity,  and  the  method  of  inheritance  of 
normal  and  pathological,  physical  and  mental  traits  in  the  lower  animals 
and  in  man. 


171 


172  CONGENITAL  AND  ACQUIRED  PREDISPOSITION  AND  HEREDITY 

In  a similar  fashion  geneticists  will  gain  new  inspiration  and  make 
great  progress  by  utilizing  the  material  which  medical  men  can  place 
at  their  disposal.  The  fields  of  comparative  embryology,  comparative 
pathology,  bacteriology,  physiology,  psychiatry,  immunology,  pedi- 
atrics, and  most  other  branches  of  the  medical  sciences  are  rich  with 
problems  for  biologists  and  geneticists.  The  benefits  which  will  result 
from  cooperation  between  genetics  and  medicine  are  therefore  mutual, 
important,  and  immediate. 

To  convince  medical  men  of  this,  however,  it  will  be  necessary  to 
place  before  them  the  more  striking  discoveries  of  genetics,  to  explain 
their  value  to  medical  practice  and  research,  and  to  point  out  the  ways 
in  which  medical  men  with  a biological  point  of  view  thus  established 
can  and  will  provide  a great  body  of  trained  observers  and  investigators 
who  will  continually  add  in  an  accurate  and  logical  way  to  our  knowl- 
edge of  human  heredity. 

In  no  other  way  can  the  study  of  human  heredity  be  so  successfully 
pursued  and  be  made  of  permanent  value  and  of  self  perpetuating  and 
ever  increasing  extent  and  interest. 

In  this  chapter  therefore,  we  shall  consider  in  some  detail  the  more 
important  discoveries  in  the  general  field  of  experimental  genetics; 
we  shall  then  deal  with  the  particular  phase  of  human  inheritance, 
and  lastly,  we  shall  consider  the  practical  and  utilizable  value  of  the 
results  already  obtained. 

In  treating  these  subjects,  the  attitude  taken  may,  at  some  points, 
seem  to  be  dogmatic.  In  such  event  the  reader  is  asked  to  remember 
that  what  we  are  striving  for  is  a point  of  view,  a mental  attitude,  and 
that  therefore  apparently  radical  statements  must  be  taken  on  trust, 
later  to  be  modified  and  limited,  if  necessary,  by  a more  thorough 
investigation  of  all  the  points  in  question  which  is  certain  to  follow 
the  adoption  of  the  viewpoint  desired. 

Genetics  is  young,  vigorous,  and  perhaps  in  certain  respects,  over 
enthusiastic,  but  it  has  won  its  spurs  and  proven  its  worth  biologically. 
It  will  moreover,  provide  a biological  approach  to  many  of  the  ques- 
tions most  interesting  to  medical  men. 

The  pediatrician  is  in  a peculiarly  strong  position  in  respect  to  the 
material  with  which  he  works.  The  child,  although  complicated,  is 
not  so  much  the  product  of  environmental  factors,  as  is  the  adult  with 
the  accumulation  of  years  of  training  and  artificial  influences.  The  child 
is  far  more  a product  of  purely  biological  factors  and  less  a combination 
of  biology  and  sociology,  inseparably  and  confusingly  interwoven. 

This  fact  has  been  but  little  recognized  by  students  of  human 
inheritance  who  have  expended  by  far  the  greater  part  of  their  efforts 
and  energies  in  the  investigation  and  analysis  of  the  inheritance  of 
adult  traits.  We  may  therefore,  expect  a surer  and  more  rapid  return 
from  a study  of  the  child,  than  from  that  of  the  adult,  and  we  may  hope 
that  the  pediatrician  will  be  among  the  first  of  the  medical  profession 
to  see  the  value  of,  and  grasp  the  opportunities  of  a genetic  point  of 
view. 


DISTINCTION  BETWEEN  TRANSMISSION  AND  HEREDITY 


173 


Illustrations  and  facts  will  be  presented  based  on  investigations 
with  adult  humans  and  with  lower  animals  or  even  plants.  As  they 
are  taken  up,  however,  it  should  become  clear  that  the  facts  of  varia- 
tion and  inheritance  have  a common  origin  and  behavior  in  high  and 
low  forms.  Once  this  is  perceived  and  recognized  the  data  of  many 
investigators  become  available  to  guide  and  to  assist  in  outlining 
the  genetic  phases  of  medicine  in  general,  and  of  pediatrics  in 
particular. 

If  then  this  chapter  assists  the  reader  in  obtaining  a biological 
viewpoint  and  stimulates  him  to  adopt  an  inquiring  and  cooperative 
attitude  towards  the  genetic  nature  of  his  material — it  will  have 
amply  justified  its  existence,  and  will  have  gone  far  towards  giving 
inheritance  its  rightful  place  in  a system  of  pediatrics. 

II.  DISTINCTION  BETWEEN  TRANSMISSION  AND  HEREDITY 

One  of  the  first  points  to  be  made  clear  is  just  what  facts  or  cate- 
gories of  phenomena  are  to  be  included  under  our  definition  of  heredity. 

Broadly  speaking,  any  substance  or  any  characters  developing  from 
any  substance  passed  by  one  generation  to  another  may  be  considered 
as  inherited.  It  is  possible,  however,  at  the  outset  to  draw  a distinc- 
tion between  substance  actually  transmitted  as  so  much  baggage  by 
the  germ  cells  such  as  the  organism  for  syphilis  on  one  hand,  and  the 
inherent  parts  of  the  biochemical  constituents  of  the  germ  cell  which  are 
the  underlying  causative  determinants  of  the  truly  genetic  characters 
of  the  organism. 

We  shall  therefore,  consider  as  merely  transmitted  substances  or 
bodies  carried  as  passengers  by  the  germ  cell  from  one  generation  to 
another.  Such  materials  do  not  react  in  any  measurable  or  recogniz- 
able way  upon  the  cells  which  carry  them,  but  retain  their  distinct 
and  characteristic  form.  Their  presence  or  absence  in  any  germ  cell 
is  due  to  their  being  placed  there  bodily  by  some  definite  physical 
process — such  as  infection,  inoculation  or  through  the  medium  of  the 
blood  stream.  They  are  normally  substances  or  bodies  capable  of 
independent  existence  outside  of  the  germ  plasm — in  the  form  in 
which  they  are  transmitted. 

In  this  respect,  they  form  a marked  contrast  with  the  truly  heredi- 
tary factors  or  determinants  which  are  an  essential  part  of  the  cell 
organization  and  which  are  or  have  been  up  to  the  present  time 
inseparable  from  it.  These  determinants  appear  to  be  highly  specific 
in  nature  and  in  many  cases  complicated  in  structure.  As  will  be 
seen,  later,  the  analysis  and  prediction  of  genetic  results  on  the 
hypothesis  of  the  existence,  the  unit  nature,  and  the  definite  position 
within  the  cell  of  such  determinants  have  been  the  chief  lines  of  progress 
in  experimental  genetics  during  the  past  twenty  years. 

We  may  then  consider  the  behavior  of  a transmissable  character  in 
slightly  more  detail,  in  order  to  contrast  it  later  with  examples  of  true 
inheritance. 


174  CONGENITAL  AND  ACQUIRED  PREDISPOSITION  AND  HEREDITY 

In  this  connection  the  experiments  of  Riddle,  the  Gages,  and 
others,  with  the  dye  Sudan  III  are  of  interest.  Sudan  III  is  a dye 
which  stains  fatty  tissue  red.  It  becomes  attached  to  fatty  particles 
within  the  body  and  remains  with  them  wherever  they  go.  It  follows 
therefore,  that  if  and  when  the  particles  of  fat  pass  through  the  follicu- 
lar membranes  and  into  the  egg,  they  will,  if  they  be  stained  with 
Sudan  III,  carry  it  with  them  and  thus  transfer  it  to  the  embryo. 
The  simple  and  mechanical  nature  of  this  process  as  well  as  its  dis- 
tinction from  what  we  ordinarily  consider  as  inheritance  has  been 
recognized  and  pointed  out  by  Riddle  (1910)  in  the  fowl  as  follows: 

“ . . . While  in  the  body,  Sudan  III  clings  at  all  times  to  the 
fats  or  their  constituent  fatty  acids,  and  so  goes  quite  mechanically 
wherever  these  particles  go;  it  is  indeed  attached  to  them.”  And 
again : 

“ . . . Within  the  ovum  the  Sudan  III  is  deposited  in  the  germi- 
nal disc  and  in  the  latebra  in  smaller  amounts  than  elsewhere.  This 
is  undoubtedly  to  be  associated  with  the  lower  fat  content  of  these 
regions  of  the  egg.” 

“If  now  one  compares  and  contrasts  these  processes  with  those 
known  to  accompany  inheritance;  i.e.,  developmental  processes,  some 
interesting  features  appear.  There  is,  to  be  sure,  transmission  of  the 
dye  from  soma  to  germ;  there  is  a 'persistence  of  that  which  is  trans- 
mitted to  such  an  extent  as  to  cause  the  soma  obviously  to  display  the 
“new  character.”  If  the  body  fat  in  the  chick  were  used  up  in  egg 
production  as  was  elsewhere  noted,  some  of  the  djre  would  of  necessity 
again  be  deposited  in  the  several  eggs  next  formed;  these  eggs  would  in 
turn  supply  the  somatic  tissues  developing  from  them.  But  this  tnust 
inevitably  come  to  an  end  in  a few  generations;  the  stain  sooner  or  later 
will  become  diluted  to  the  vanishing  point.  Again  there  is  absolutely 
no  growth  of  the  material  forming  the  “character,”  nor  is  there  any 
chemical  change  either  in  early  or  in  late  phases  of  the  life  cj'cle.” 

We  have  then  in  such  a case  as  this,  the  simplest  type  of  a trans- 
missible character  which  is  carried  into  the  germ  cell  but  which  remains 
chemically  unchanged  and  a passive  agent  until  so  diluted  by  purely 
mechanical  distribution  that  it  does  not  visibly  express  its  presence. 

Very  similar  to  this  case  is  that  of  so-called  “hereditary”  syphilis. 
Here  the  syphilis  organism  is  the  actual  material  handed  on  from  parent 
to  offspring.  In  cases  where  successful  transmission  from  parent  to 
offspring  takes  place  through  an  uninfected  parent,  the  organism  is 
borne  as  a passenger  by  the  sex  cells  of  the  affected  parent.  Following 
its  usual  habit,  the  organism  multiplies  in  the  tissue  in  which  it  finds 
itself  with  the  result  that  the  fetus  is  infected.  If  now  the  fetus 
matures  and  though  suffering  from  the  disease  reaches  birth  and  grows 
to  sexual  maturity,  there  is,  entirely  outside  of  the  chance  of  contact 
infection,  an  opportunity  for  its  germ  cells  in  turn  to  actually  transmit 
the  organisms  to  an  uninfected  individual  and  so  to  repeat  the  process 
above  outlined. 

Of  course,  in  such  cases,  germ  cells  might,  and  probably  would  be 


DISTINCTION  BETWEEN  TRANSMISSION  AND  HEREDITY 


175 


formed  free  from  the  syphilis  organism,  due  to  the  mechanical  nature 
of  the  process  by  which  the  organism  is  distributed  through  the 
tissueso  It  will  be  observed  that  there  is  obviously  no  way  of  predicting 
what  'proportion  if  any  of  the  germ  cells  of  a given  individual  are  going 
to  carry  the  organism.  This  is  in  marked  contrast  with  true  inheri- 
tance, the  nature  of  which  we  shall  later  consider. 

A moment’s  consideration  will  serve  to  make  clear  the  points  of 
similarity  between  these  two  cases.  In  the  first  place  the  materials 
transmitted  retain  their  identity  without  chemical  change,  in  the  second 
place  they  are  both  transferred  from  soma  to  germ  by  a mechanical 
process,  as  an  outside  or  foreign  body  and  finally  they  persist  and 
reappear  unmodified  in  the  somatic  cells,  of  the  next  generation. 

We  may  next  consider  a slightly  different  category  of  cases,  namely 
those  in  which  attempts  have  been  made  to  modify  the  germ  cells  by 
external  agents,  either  physical  or  chemical.  Among  the  numerous 
efforts  made  along  these  lines  two  sets  of  experiments  stand  out  clearly. 
The  first  of  these  is  work  with  radium  and  the  second  is  treatment  with 
alcohol  vapor. 

A.  Experiments  with  Radium. — The  destructive  effects  of  radium 
on  living  tissue  as  evidenced  by  its  ability  to  inflict  severe  burns  and 
its  therapeutic  value  in  the  treatment  of  cancer,  have  long  been  of 
considerable  interest  to  biologists.  Because  of  its  absorption  by  and 
influence  on  the  cell  and  particularly  the  nucleus,  radium  has  been 
used  as  a possible  modifier  of  the  germ  cell. 

Chief  among  the  experimenters  in  this  field,  are  the  Hertwigs  who 
have  carried  out  an  interesting  series  of  crosses  with  different  species 
of  frogs  and  other  cold-blooded,  water-inhabiting  animals. 

The  mechanical  advantage  of  using  for  experimentation  a form  in 
which  fertilization  normally  occurs  outside  the  body  after  the  libera- 
tion of  both  male  and  female  sex  cells  into  water,  is  very  great.  The 
sex  cells  can  be  easily  reached  for  treatment,  the  number  of  eggs 
liberated  is  commonly  very  large  and  the  course  of  development  easy 
to  observe.  These  factors  have  contributed  to  the  success  which  has 
been  obtained  by  the  Hertwigs. 

In  general  their  results  may  be  summarized  as  follows:  The  em- 
bryos resulting  from  fertilization  between  lightly  treated  sperm  and 
a normal  egg  are  malformed  and  abnormal  in  character.  The  same 
is  true  in  the  case  of  a slightly  treated  egg  fertilized  by  a normal  sperm. 
In  the  two  cases  there  is  little  if  any  difference  in  the  nature  or  extent 
of  the  abnormalities,  provided  the  dosage  of  radium  is  the  same  in 
both. 

If  either  the  sperm  or  the  egg  is  treated  for  a long  time,  and  is  then 
combined  in  fertilization  with  a normal  germ  cell,  the  result  is  most 
surprising.  Instead  of  an  increase  of  abnormalities  and  deformities  the 
resulting  embryo  is  small  but  normal,  and  its  development  is  distinctly 
slow.  Cytological  investigations  have  shown  that  such  embryos  are 
parthenogenetic.  The  radiated  germ  cell  takes  no  part  in  develop- 
ment beyond  the  actual  process  of  fertilization  and  the  nucleus  of  the 


176  CONGENITAL  AND  ACQUIRED  PREDISPOSITION  AND  HEREDITY 

normal  germ  cell  becomes  the  sole  participant  in  the  processes  of  cell 
division. 

Unfortunately  no  cases  have  been  reported  of  breeding  records  of 
the  abnormal  individuals  and  we  cannot  therefore  determine  whether 
and  in  what  degree  the  abnormalities  will  be  transmitted  to  succeeding 
generations.  The  appearance  of  abnormalities  following  light  treat- 
ment strongly  suggests  the  results  obtained  with  alcohol  vapor  by 
Stockard  with  guinea  pigs — but  the  occurrence  of  parthenogenesis 
shows  a type  of  effect  not  seen  in  the  guinea-pig  experiments.  Radium, 
because  of  its  selective  action  on  the  nucleus  is  of  especial  interest  in 
attempting  to  modify  the  germ  plasm.  Its  effects  are  undoubted,  but 
a regular  and  predictable  genetic  behavior  following  modification  of 
the  germ  plasm  without  weakening  or  partially  destroying  its  reactions 
are  still  to  be  obtained. 

B.  Experiments  with  Alcohol. — Pearl  has  carried  out  an  extensive 
series  of  experiments  to  study  the  effect  of  the  inhalation  of  alcohol 
vapor  on  the  progeny  of  the  domestic  fowl.  Throughout  his  experi- 
ments he  has  carefully  controlled  his  tests  by  a considerable  number  of 
untreated  animals.  He  has  compared  the  progeny  of  tests  and  of 
controls  in  respect  to  prenatal  and  postnatal  mortality,  occurrence  of 
abnormalities,  weight  at  hatching,  adult  weight,  rate  of  growth,  and 
total  number  of  progeny  obtained.  In  every  character  except  the 
last,  the  treated  animals  gave  a better  breeding  record  than  did  the 
controls. 

Pearl  interprets  this  as  meaning  that  there  is  a selective  mortality 
of  weaker  germ  cells,  as  a result  of  the  alcoholization,  thus  producing 
a selected  surviving  class  which  represents  zygotes  formed  from  stronger 
germ  cells  only. 

In  support  of  this  he  cites  an  interesting  experiment  in  which  a 
control  group  of  artificially  incubated  eggs  was  compared  with  groups 
of  artificially  incubated  eggs  which  had  been  subjected  to  fumes  caused 
by  the  daily  evaporation  of  40  c.c.  of  95  per  cent  ethyl  alcohol  for  one, 
two,  and  three  weeks  respectively.  The  mortality  in  the  egg  was  then 
observed  and  the  chicks  of  all  lots  marked,  and  subjected  to  rather 
poor  brooding  facilities  to  induce  a relatively  high  proportion  of  abso- 
lute mortality.  The  result  was  as  follows: 


Eggs  set 

Per  cent, 
infertile 

Per  cent,  dead 
30  days  after 
hatching 

Prenatal 
deaths  in  per 
cent,  of  fertile 
eggs 

Lot  1 — Alcohol  one  week.  . . . 

130 

26.2 

28.3 

42.7 

Lot  2 — Alcohol  two  weeks.  . . 

130 

26.9 

21.2 

43.2 

Controls 

390 

28.5 

34  1 

3S.7 

Lot  3 — Alcohol  three  weeks. 

130 

32.3 

37.5 

60.5 

It  will  be  observed  that  the  similarity  of  the  four  lots  of  eggs  as 
regards  the  percentage  of  infertility  is  marked.  The  higher  prenatal 
mortality  of  the  alcoholics  is  also  clear.  When,  however,  we  consider 


